[Delphi Consensus of Argentine Pulmonologists on the Management of Patients with COPD in Real Life]. / Consenso Delphi de neumólogos argentinos sobre el manejo de los pacientes con EPOC en la vida real.

Introduction: COPD is the third cause of death globally and in Argentina COPD has a prevalence of 14.5%, but the management of patients in real life is unknown. The objectives of this work were: a) To know the opinions of pulmonologists in Argentina who manage patients with COPD in different aspects of daily practice. b) Compare our findings with specialists from Spain and c) Consider our results to plan future directives in the management of COPD in our country. Material and methods: 89 pulmonologists from Argentina, experts in COPD, participated in a Delphi consensus, who responded to a survey with five domains. a) Adherence to treatment, b) Control of COPD, c) Treatable features, d) Inhalation devices and e) Accessibility to therapeutic resources. Results: After two rounds of questions, total consensus was achieved in 77.6% of the statements and discriminating by domain: Treatment adherence: 5/9 (55.5%). COPD control: 10/14 (71.4%). Treatable traits: 6/6 (100%). Inhalation devices: 10/14 (71.4%) and Accessibility to treatment: 6/6 (100%). In most of the affirmations, the results were similar to those obtained by Spanish pulmonologists. Conclusions: Pulmonologists from Argentina manage COPD patients in a similar way and with minimal differences with our Spanish colleagues. It became evident that, in daily practice, there are factors that negatively impact access to the indicated treatments. Our work could serve as a starting point to improve this situation.

Mortality in children with cancer and SARS-CoV-2 in Latin America: A systematic review.

The new COVID-19 disease is caused by a novel coronavirus (SARS-CoV-2), that probably originated in Wuhan, China, and has currently infected 505,817,953 people and caused 6,213,876 deaths in the world. On the American continent, 152,265,980 cases and 2,717,108 deaths have been reported to WHO (World Health Organization). The Latin America and the Caribbean (LAC) region presents an epidemiological challenge due to its population's heterogeneity and socioeconomic inequality. A particularly vulnerable population is that of children with cancer, and their mortality from COVID-19 has been reported to be 3.6% globally. This work aimed to study the lethality of SARS-CoV-2 infection in children with cancer in the Latin American region. Our objective was to systematically review published scientific literature and search hospital databases in Latin America to explore mortality in this region. A median of mortality of 9.8% was found in the articles analyzed. In addition, we collected five databases from Latin American hospitals. We concluded that there was an underestimation in the mortality registry of this group of patients in the analyzed region. Therefore, although the causes are unknown, it is necessary to strengthen the case-reporting system to determine the reality in complex and particular areas such as Latin America.

Superposición Asma-EPOC: los hallazgos en el estudio EPOC AR / Asthma-COPD Overlap: Findings of the EPOC AR Study

Introducción: Asma y EPOC son enfermedades heterogéneas, algunos pacientes comparten características clínicas de ambas. Existen incertidumbres en los criterios para definir superposición asma-EPOC (ACO) y la prevalencia es entre el 15% y el 25% de la población adulta con obstrucción crónica del flujo aéreo. Motiva este estudio determinar la prevalencia de ACO en Argentina, que es desconocida. Objetivos: Primario: Determinar prevalencia de ACO en el estudio EPOC-AR. Se cundarios: Evaluar y analizar las características clínicas de los pacientes con ACO, la gravedad de los síntomas, la frecuencia y gravedad de exacerbaciones. Describir y comparar el tratamiento entre ACO vs. EPOC puros. Base de datos del estudio EPOC.AR: Espirometrías, asma, atopía o rinitis, síntomas respiratorios: CAT (prueba de evaluación de EPOC) y mMRC (Medical Research Council modificado), frecuencia de exacerbaciones/año previo, comorbilidades y tratamientos. Guías GOLD 2017 para determinar grados de obstrucción espirométrica y Grupos A, B, C y D. Criterios diagnósticos de ACO (comité expertos USA, Europa del Este y Asia-Denver 2015): CRITERIOS MAYORES: 1. Obstrucción persistente (FEV1/FVC pos-BD <70% o LIN) en ≥ 40 años. 2. TBQ ≥ 10 paquetes/año, contaminación ambiental o biomasa. 3. Historia documentada de asma antes de los 40 años o respuesta pos-BD ≥ 400 mL en FEV1. CRITERIOS MENORES: 1. Historia documentada de atopía o rinitis alérgica. 2. Res puesta pos-BD en FEV1 > 200 mL. 3. Recuento de eosinófilos en sangre periférica ≥ 300 células-Ul-1 (no realizado en EPOC.AR). Prueba de Chi-cuadrado, Chi-cuadrado de Pearson, razón de verosimilitud, asociación lineal por lineal. Resultados: EPOC (n498), n95 con criterios de ACO, masculino (53,4%) y edad pro medio 63,6 años. El 1%, sin asma y respuesta BD ≥ 400 mL; el 32,7%, asmáticos (3,6% respuesta BD ≥ 400 mL y el 14,5%, entre 200-400 mL); n23 respuesta BD ≥ 400 mL (4,6%). Prevalen cia ACO: 19,08% (IC 15,6-22,5) y del 2,6% del total de la población de EPOC.AR. En población ACO vs. EPOC, se detectó: menor promedio de edad y de FEV1 pre BD (p < 0,01), mayor respuesta BD (p < 0,05), mayor frecuencia de sibilancias (p < 0,01; IC 2,75-7,64), mayor frecuencia de diagnóstico previo de asma (p < 0,01; IC 3,79-10,05) y el 26,08% tenían antecedentes familiares de asma. Mayor uso de ATB (p < 0,05) e ICS/LABA (p < 0,05; IC 1,1-5,3). Mayor frecuencia de exacerbaciones (12,47%; IC 9,56-15,39) que motivaron indicación de medicación en un 90,48% y 2,49 veces más de alteraciones en actividades diarias y ausentismo laboral. No se registraron diferencias significativas entre pacientes con ACO frente a EPOC puros en frecuencia de grupos A, B, C y D. Conclusiones: La prevalencia de ACO fue del 19,08% en pacientes EPOC del es tudio EPOC.AR; tenían significativamente menor edad, mayor grado de obstrucción, frecuencia de sibilancias, uso de antibióticos/año previo y CI (LABA/CI). Destacamos la importancia de identificar este fenotipo para un tratamiento adecuado por sus impli cancias clínicas, y deterioro en calidad de vida.

Background: Asthma and COPD are heterogeneous diseases, and some patients share clinical features of both conditions. There are uncertainties about the criteria to define asthma-COPD overlap (ACO), and its prevalence is 15-25% in the adult population with chronic airflow obstruction. The purpose of this study was to determine the prevalence of ACO in Argentina, which is unknown. Objectives: Primary: to determine the prevalence of ACO in the EPOC.AR study. Secondary: to evaluate and analyze the clinical features of patients with ACO, the severity of the symptoms, and the frequency and severity of exacerbations. to describe and compare the treatment of ACO with that of pure COPD. Database of the EPOC.AR study: spirometries, asthma, atopy or rhinitis, respiratory symptoms: CAT (COPD Assesment Test) and mMRC (Modified Medical Research Council) scale, frequency of exacerbations/previous year, comorbidities and treatments. 2017 GOLD Guides (Global Initiative for Chronic Obstructive Lung Disease) to determine airflow obstruction degrees and Groups A, B, C, and D. ACO diagnostic criteria (expert committee from USA, East Europe and Asia that took place in Denver, 2015): MAJOR CRITERIA: 1. Persistent obstruction (post-BD [bronchodilator] FEV1/FVC (forced expiratory volume in the first second/forced vital capacity) < 70% or LLN [lower limit of normal] ) in ≥ 40 years. 2. SM (smoking) ≥ 10 packs/year, air pollution or biomass. 3. Documented history of asthma before 40 years or post-BD response ≥ 400 ml in FEV1. MINOR CRITERIA: 1. Documented history of atopy or allergic rhinitis. 2. Post-BD response in FEV1 > 200 ml. 3. Peripheral blood eosinophil count ≥ 300 cells-Ul-1 (not performed in EPOC.AR). Chi-Square Test, Pearson's Chi Square Test, likelihood ratio, linear-by-linear association. Results: COPD (n 498), n 95 with ACO criteria, males (53.4%), mean age 63.6 years. 1% without asthma and BD response ≥ 400 ml; 32.7% asthmatics (3.6% with BD response ≥ 400 ml and 14.5% between 200-400 ml); n 23 with BD response ≥ 400 ml (4.6%). ACO prevalence: 19.08% (CI [Confidence Interval] 15.6-22.5) and 2.6% of the total population of EPOC.AR. In the comparison between the ACO and COPD populations, we detected the following: lower mean age and pre-BD FEV1 (p < 0.01), higher frequency of BD response (p < 0.05), higher frequency of sibilance (p < 0.01; CI 2.75-7.64), higher frequency of previous asthma diagnosis (p < 0.01; CI 3.79-10.05); and 26.08% had family history of asthma. Greater use of ATBs (antibiotics) (p < 0.05) and ICS (inhaled corticosteroids)/ LABA (long-acting beta- adrenergic agonists) (p < 0.05; CI 1.1-5.3). Higher frequency of exacerbations (12.47%; CI 9.56-15.39) that motivated the indication of medication in 90.48% and 2.49 times more alterations in daily activities and absence from work. There weren't any significant differences between patients with ACO and pure COPD regarding frequency of groups A, B, C and D. Conclusions: the prevalence of ACO was 19.08% in the COPD patients of the EPOC. AR study; they were significantly younger, with higher degree of obstruction, frequency of sibilance, use of antibiotics/previous year and inhaled corticosteroids (LABA/IC). We emphasize the importance of identifying this phenotype in order to use a suitable treat ment, given its clinical implications and deterioration in quality of life.

Asthma-COPD Overlap: Findings of the EPOC.AR Study / Superposición Asma-EPOC: los hallazgos en el estudio EPOC AR

ABSTRACT Background: Asthma and COPD are heterogeneous diseases, and some patients share clinical features of both conditions. There are uncertainties about the criteria to define asthma-COPD overlap (ACO), and its prevalence is 15-25% in the adult population with chronic airflow obstruction. The purpose of this study was to determine the prevalence of ACO in Argentina, which is unknown. Objectives: Primary: to determine the prevalence of ACO in the EPOC.AR study. Secondary: to evaluate and analyze the clinical features of patients with ACO, the severity of the symptoms, and the frequency and severity of exacerbations. to describe and compare the treatment of ACO with that of pure COPD. Database of the EPOC.AR study: spirometries, asthma, atopy or rhinitis, respiratory symptoms: CAT (COPD Assesment Test) and mMRC (Modified Medical Research Council) scale, frequency of exacerbations/previous year, comorbidities and treatments. 2017 GOLD Guides (Global Initiative for Chronic Obstructive Lung Disease) to determine airflow obstruction degrees and Groups A, B, C, and D. ACO diagnostic criteria (expert committee from USA, East Europe and Asia that took place in Denver, 2015): MAJOR CRITERIA: 1. Persistent obstruction (post-BD [bronchodilator] FEV1/FVC (forced expiratory volume in the first second/forced vital capacity) < 70% or LLN [lower limit of normal] ) in ≥ 40 years. 2. SM (smoking) ≥ 10 packs/year, air pollution or biomass. 3. Documented history of asthma before 40 years or post-BD response ≥ 400 ml in FEV1. MINOR CRITERIA: 1. Documented history of atopy or allergic rhinitis. 2. Post-BD response in FEV1 > 200 ml. 3. Peripheral blood eosinophil count ≥ 300 cells-Ul-1 (not performed in EPOC.AR). Chi-Square Test, Pearson's Chi Square Test, likelihood ratio, linear-by-linear association. Results: COPD (n 498), n 95 with ACO criteria, males (53.4%), mean age 63.6 years. 1% without asthma and BD response ≥ 400 ml; 32.7% asthmatics (3.6% with BD response ≥ 400 ml and 14.5% between 200-400 ml); n 23 with BD response ≥ 400 ml (4.6%). ACO prevalence: 19.08% (CI [Confidence Interval] 15.6-22.5) and 2.6% of the total population of EPOC.AR. In the comparison between the ACO and COPD populations, we detected the following: lower mean age and pre-BD FEV1 (p < 0.01), higher frequency of BD response (p < 0.05), higher frequency of sibilance (p < 0.01; CI 2.75-7.64), higher frequency of previous asthma diagnosis (p < 0.01; CI 3.79-10.05); and 26.08% had family history of asthma. Greater use of ATBs (antibiotics) (p < 0.05) and ICS (inhaled corticosteroids)/ LABA (long-acting beta- adrenergic agonists) (p < 0.05; CI 1.1-5.3). Higher frequency of exacerbations (12.47%; CI 9.56-15.39) that motivated the indication of medication in 90.48% and 2.49 times more alterations in daily activities and absence from work. There weren't any significant differences between patients with ACO and pure COPD regarding frequency of groups A, B, C and D. Conclusions: the prevalence of ACO was 19.08% in the COPD patients of the EPOC. AR study; they were significantly younger, with higher degree of obstruction, frequency of sibilance, use of antibiotics/previous year and inhaled corticosteroids (LABA/IC). We emphasize the importance of identifying this phenotype in order to use a suitable treat ment, given its clinical implications and deterioration in quality of life.

RESUMEN Introducción: Asma y EPOC son enfermedades heterogéneas, algunos pacientes comparten características clínicas de ambas. Existen incertidumbres en los criterios para definir superposición asma-EPOC (ACO) y la prevalencia es entre el 15% y el 25% de la población adulta con obstrucción crónica del flujo aéreo. Motiva este estudio determinar la prevalencia de ACO en Argentina, que es desconocida. Objetivos: Primario: Determinar prevalencia de ACO en el estudio EPOC-AR. Se cundarios: Evaluar y analizar las características clínicas de los pacientes con ACO, la gravedad de los síntomas, la frecuencia y gravedad de exacerbaciones. Describir y comparar el tratamiento entre ACO vs. EPOC puros. Base de datos del estudio EPOC.AR: Espirometrías, asma, atopía o rinitis, síntomas respiratorios: CAT (prueba de evaluación de EPOC) y mMRC (Medical Research Council modificado), frecuencia de exacerbaciones/año previo, comorbilidades y tratamientos. Guías GOLD 2017 para determinar grados de obstrucción espirométrica y Grupos A, B, C y D. Criterios diagnósticos de ACO (comité expertos USA, Europa del Este y Asia-Denver 2015): CRITERIOS MAYORES: 1. Obstrucción persistente (FEV1/FVC pos-BD <70% o LIN) en ≥ 40 años. 2. TBQ ≥ 10 paquetes/año, contaminación ambiental o biomasa. 3. Historia documentada de asma antes de los 40 años o respuesta pos-BD ≥ 400 mL en FEV1. CRITERIOS MENORES: 1. Historia documentada de atopía o rinitis alérgica. 2. Respu esta pos-BD en FEV1 > 200 mL. 3. Recuento de eosinófilos en sangre periférica ≥ 300 células-Ul-1 (no realizado en EPOC.AR). Prueba de Chi-cuadrado, Chi-cuadrado de Pearson, razón de verosimilitud, asociación lineal por lineal. Resultados: EPOC (n498), n95 con criterios de ACO, masculino (53,4%) y edad pro medio 63,6 años. El 1%, sin asma y respuesta BD ≥ 400 mL; el 32,7%, asmáticos (3,6% respuesta BD ≥ 400 mL y el 14,5%, entre 200-400 mL); n23 respuesta BD ≥ 400 mL (4,6%). Prevalen cia ACO: 19,08% (IC 15,6-22,5) y del 2,6% del total de la población de EPOC.AR. En población ACO vs. EPOC, se detectó: menor promedio de edad y de FEV1 pre BD (p < 0,01), mayor respuesta BD (p < 0,05), mayor frecuencia de sibilancias (p < 0,01; IC 2,75-7,64), mayor frecuencia de diagnóstico previo de asma (p < 0,01; IC 3,79-10,05) y el 26,08% tenían antecedentes familiares de asma. Mayor uso de ATB (p < 0,05) e ICS/LABA (p < 0,05; IC 1,1-5,3). Mayor frecuencia de exacerbaciones (12,47%; IC 9,56-15,39) que motivaron indicación de medicación en un 90,48% y 2,49 veces más de alteraciones en actividades diarias y ausentismo laboral. No se registraron diferencias significativas entre pacientes con ACO frente a EPOC puros en frecuencia de grupos A, B, C y D. Conclusiones: La prevalencia de ACO fue del 19,08% en pacientes EPOC del es tudio EPOC.AR; tenían significativamente menor edad, mayor grado de obstrucción, frecuencia de sibilancias, uso de antibióticos/año previo y CI (LABA/CI). Destacamos la importancia de identificar este fenotipo para un tratamiento adecuado por sus impli cancias clínicas, y deterioro en calidad de vida.

SARS-CoV-2 seroprevalence in the city of Puerto Madryn: Underdiagnosis and relevance of children in the pandemic.

BACKGROUND: Reported cases of COVID-19 may be underestimated due to mild or asymptomatic cases and a low testing rate in the general population. RESEARCH QUESTION: What is the seroprevalence of SARS-CoV-2 infection in the general population and how it compares with the data on SARS-CoV-2 cases reported by a national health surveillance system (SNVS 2.0). STUDY DESIGN AND METHODS: This was a population-based, seroepidemiological, cross-sectional study in the city of Puerto Madryn, a middle size city in the Province of Chubut, Argentina. The study period was between March 3 and April 17, 2021. The sample size was calculated using the technique of calculation of confidence intervals for a proportion. Participants were selected using stratified and cluster probability sampling. A total of 1405 subjects were invited to participate in the study. Participants were divided into the following four age groups: 1) 0 to 14, 2) 15 to 39, 3) 40 to 64, and 4) 65 or older. After informed consent was obtained, a blood sample was taken by puncture of the fingertip, and a structured questionnaire was administered to evaluate demographics, socioeconomic status, level of education, comorbidities and symptoms suggestive of COVID-19. COVID-19 seroprevalence was documented using an immunoenzymatic test for the in vitro detection of IgG antibodies specific to the spike protein of SARS-CoV-2. RESULTS: A total of 987 participants completed the survey. Seropositivity in the full study population was 39,2% and in those under 15 years of age, 47.1%. Cases reported by the SNSV 2.0 amounted to 9.35% of the total population and 1.4% of those under 15 years of age. INTERPRETATION: The prevalence of COVID-19 infection in the general population is four times higher than the number of cases reported by the SNVS 2.0 in the city of Puerto Madryn. For each child under the age of 15 identified by the SNVS 2.0 with COVID-19, there are more than 30 unrecognized infections. Seroepidemiological studies are important to define the real extent of SARS-CoV-2 infection in a particular community. Children may play a significant role in the progression of the current pandemic.

Examining the Item-Level Factor Structure of the Behavior Rating Inventory of Executive Function-Adult Version Within a Traumatic Brain Injury Sample.

OBJECTIVE: To conduct the first item-level exploration of scale and index structure of the self-report Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) in traumatic brain injury (TBI). DESIGN: This was an observational cross-sectional study design using secondary data. We conducted exploratory factor analyses (EFA) to explore the index structure and scale structure of the BRIEF-A. We conducted EFA with all 70 items of the BRIEF-A to examine the index structure. Based on the finding of index structure, we conducted EFA on the 30 items of the Behavioral Regulation Index (BRI) and the 40 items of the Metacognitive Index (MI). SETTING: Data were collected through 5 studies in outpatient and community settings in the southeast United States. PARTICIPANTS: Individuals (N=338) aged 18-89 years with a history of mild to severe TBI who were able to speak English fluently. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The BRIEF-A. RESULTS: The 2-factor structure aligned with the BRIEF-A manual at the index level. Scale structure for the MI (40 items) resulted in 1 factor, whereas the BRI (30 items) could be represented by either a 2- or 3-factor structure. The 2-factor structure of the BRI is more parsimonious and matched other factor analyses derived from the sum of scale items. CONCLUSIONS: We confirmed the manual designated index structure (BRI and MI) of the BRIEF-A but took precautions against using the 9 scales. Instead, we recommend using the 2 designated index scores and 2 newly identified composite scores representing Behavioral Control Trait and Emotional Control Trait.

Case report: Thrombus in transit-a cause of impending paradoxical embolism.

BACKGROUND: A thrombus in transit (TIT) is a life-threatening condition associated with pulmonary embolism (PE). While TIT was once considered a rare diagnosis, its emergence has risen in recent years mainly through advancement in medical technology. Rare cases of a thrombus in transit crossing a patent foramen ovale in the context of pulmonary embolism have been reported. The appropriate treatment of patients in this setting remains unclear. CASE SUMMARY: We describe a 64-year-old man who presented with syncope to the emergency room secondary to acute pulmonary embolism. Initial transthoracic echocardiogram revealed a large intracardiac thrombus in transit across a patent foramen ovale, verified by transoesophageal echocardiogram. He underwent anticoagulation and urgent surgical thrombectomy with a favourable outcome. DISCUSSION: Risk stratification of patient with acute PE is mandatory for determining the appropriate therapeutic management. Initial risk stratification is based on clinical symptoms and signs of haemodynamic instability which indicate a high risk or early death associated massive PE. Thrombolytic therapy is indicated in high-risk patients (Grade 1B), while anticoagulation alone is recommended for intermediate-high- to low-risk patients. Assessment for intracardiac thrombi in PE modifies the treatment strategy in case of a thrombus in transit.

Clinical presentation and outcomes of the first patients with COVID-19 in Argentina: Results of 207079 cases from a national database.

BACKGROUND: There is limited evidence on the clinical characteristics of SARS-CoV-2 infection in Latin America. We present findings from a nationwide study in Argentina. RESEARCH QUESTION: What is disease severity measures and risk factors are associated with admission to an intensive care unit and mortality? STUDY DESIGN AND METHODS: Data were extracted from the COVID-19 database of the Integrated Argentina Health Information System, encompassing the period of March 3rd to October 2nd, 2020, using a standardized case report form that included information on contact history, clinical signs and symptoms, and clinical diagnosis. Information was collected at the initial site of care and follow-up conducted through calls by the regional healthcare authorities. A confirmed case of COVID-19 was defined as having a positive result through sequencing or real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. RESULTS: RT-PCR testing was positive in 738,776 cases. Complete datasets were available for analysis in 207,079 cases. Mean age was 42.9±18.8 years, 50.0% were males. Frequent co-existing conditions included hypertension (19.2%), diabetes (9.7%), asthma (6.1%) and obesity (5.2%). Most common symptoms included fever (58.5%), cough (58.0%), headache (45.4%), and sore throat (42.1%). Death or ICU admission were independently associated with older age, male, coma, dyspnea or tachypnea, and seizures, with underlying co-morbidities such as immunodeficiency, chronic renal failure, and liver disease showing the strongest effects. INTERPRETATION: Most cases of COVID-19 diagnosed in Argentina were mild and had a favorable outcome, but fatality rates were relatively elevated. Risk factors for adverse outcome included older age, male sex, coma and seizures, and the concurrent presence of several morbidities. These data may be useful for healthcare providers and healthcare policy makers of low-middle income and Latin American countries to guide decisions toward optimized care during the pandemic.

¿Cómo son los fumadores del EPOC. AR? Características de tabaquismo en población con y sin EPOC / How are COPD. AR smokers? Smoking Characteristics of Populations With and Without COPD

Introducción: Entre 2014 y 2016, se realizó en Argentina el estudio EPOC.AR, a fin de determinar la prevalencia de EPOC en el país. El presente trabajo se realizó para comparar las características de tabaquismo en fumadores con y sin EPOC de dicho estudio, conocer cuántos recibieron Consejo Médico, las características de sus intentos previos de abandono y la exposición a humo de tabaco de segunda mano. Material y Métodos: La asociación entre tabaquismo y sus características y EPOC se evaluó por Odds Ratio, su intervalo de confianza del 95% y valor p correspondiente al test de hipótesis, utilizando la técnica de chi cuadrado. Resultados: Se incluyeron 3469 encuestas en mayores de 39 años, 42.2% hombres. Fueron fumadores actuales o anteriores 70.7% y el 53.3% de ellos tenía características espirométricas de EPOC. El 34.7% es fumador actual, de los que 73,4% piensa en dejar de fumar, 64% recibió consejo y sólo 7.3% refiere haber utilizado algún tratamiento. El 40.2% de los encuestados refirió exposición a humo ambiental y el 56.1% refirió exposición laboral a humo de tabaco: Entre los fumadores del EPOC.AR, la mayoría fuman menos de 20 cigarrillos por día, hay mayor prevalencia de EPOC en hombres y mayor porcentaje de nunca fumadores con EPOC en mujeres. Alto porcentaje piensa dejar de fumar, algo menor en los que tienen EPOC, que tuvieron más intentos previos de dejar. Casi la mitad no recibió consejo médico y muy bajo porcentaje utilizó fármacos para dejar. Existe alta exposición a humo de segunda mano en casas y trabajo. Conclusiones: los fumadores del EPOC.AR fuman menos de 20 cigarrillos/día, hay más hombres, una alto porcentaje quiere dejar y muy pocos reciben consejo médico o fármacos.

How are COPD. AR smokers? Smoking Characteristics of Populations With and Without COPD / ¿Cómo son los fumadores del EPOC. AR? Características de tabaquismo en población con y sin EPOC

Introduction: The COPD.AR Study was conducted between 2014 and 2016 in Argentina to determine the prevalence of COPD in the country. This work was carried out to compare the smoking characteristics of smokers with and without COPD of said study, to know how many of them received medical advice, the characteristics of their previous attempts to quit and their exposure to secondhand tobacco smoke. Materials and Methods: The association between smoking characteristics and COPD was evaluated by Odds Ratio, its 95% confidence interval and p value corresponding to the hypothesis test, using the chi square technique. Results: We included 3469 surveys of subjects older than 39 years, 42.2% men. 70.7% were current or former smokers and 53.3% had spirometric characteristics of COPD. 34.7% are current smokers, 73.4% out of which think about quitting; 64% received advice about it and only 7.3% reported having used some treatment. 40.2% of the respondents reported exposure to environmental smoke, and 56.1% reported occupational exposure to tobacco smoke. The majority of COPD.AR smokers smoke less than 20 cigarettes per day; there is a higher prevalence of COPD in men and a higher percentage of never smokers with COPD in women. A high percentage thinks of quitting smoking, a little lower among patients with COPD, who had more previous attempts to quit. Almost half of the subjects did not receive any medical advice and a very low percentage used drugs to quit. There is high exposure to secondhand smoke in homes and workplaces. Conclusions: COPD.AR smokers smoke less than 20 cigarettes a day; there are more men, a high percentage want to quit and very few receive medical advice or drugs.

[Infant mortality and social inequalities in Argentina, 1980-2017]. / Mortalidad infantil y desigualdades sociales en Argentina, 1980-2017.

OBJECTIVE: To estimate the trend in infant mortality, inequality between jurisdictions and inequality associated with social conditions in Argentina between 1980 and 2017. METHODS: Ecological and time series study of infant mortality and its inequality. Official data on infant mortality, births and unmet basic needs were obtained; the infant mortality rate, the Gini index and the concentration index were calculated. The trend was also analyzed with a linear regression model and the regression coefficient and its statistical significance were calculated. RESULTS: Infant mortality was reduced by 71.2% (from 32.41 to 9.34 per 1 000 live births). Inequality by jurisdiction also decreased, and the Gini index fell from 0,163 to 0,09. Inequality associated with social conditions also showed a reduction, and the concentration index was reduced from -0.153 to -0.079. Although infant mortality declined throughout the period, this decline was not always accompanied by a reduction in the Gini index and the concentration index. CONCLUSIONS: The trend in the infant mortality rate decreased while the inequality in its distribution by jurisdiction and the inequality associated with social conditions did not always accompany this reduction.

Mortalidad infantil y desigualdades sociales en Argentina, 1980-2017

[RESUMEN]. Objetivo. Estimar la tendencia de la mortalidad infantil, de la desigualdad entre jurisdicciones y de la desigualdad asociada a las condiciones sociales en Argentina entre 1980 y 2017. Métodos. Estudio ecológico y de serie temporal de la mortalidad infantil y de su desigualdad. Se obtuvieron los datos oficiales de mortalidad infantil, de nacimientos y de necesidades básicas insatisfechas; se calculó la tasa de mortalidad infantil, el índice de Gini y el índice de concentración. También se analizó la tendencia con un modelo de regresión lineal y se calculó el coeficiente de regresión y su significación estadística. Resultados. La mortalidad infantil se redujo 71,2% (de 32,41 a 9,34 por 1 000 nacidos vivos). La desigualdad por jurisdicción también se redujo y el índice de Gini pasó de 0,163 a 0,09. La desigualdad asociada a las condiciones sociales también mostró una reducción, y el índice de concentración disminuyó de -0,153 a -0,079. Si bien la mortalidad infantil se redujo en todo el período, este descenso no siempre se acompañó de una reducción del índice de Gini y del índice de concentración. Conclusiones. La tendencia de la tasa de mortalidad infantil fue al descenso mientras que la desigualdad en su distribución por jurisdicción y la desigualdad asociada a las condiciones sociales no siempre acompañaron esa reducción.

[ABSTRACT]. Objective. To estimate the trend in infant mortality, inequality between jurisdictions and inequality associated with social conditions in Argentina between 1980 and 2017. Methods. Ecological and time series study of infant mortality and its inequality. Official data on infant mortality, births and unmet basic needs were obtained; the infant mortality rate, the Gini index and the concentration index were calculated. The trend was also analyzed with a linear regression model and the regression coefficient and its statistical significance were calculated. Results. Infant mortality was reduced by 71.2% (from 32.41 to 9.34 per 1 000 live births). Inequality by jurisdiction also decreased, and the Gini index fell from 0,163 to 0,09. Inequality associated with social conditions also showed a reduction, and the concentration index was reduced from -0.153 to -0.079. Although infant mortality declined throughout the period, this decline was not always accompanied by a reduction in the Gini index and the concentration index. Conclusions. The trend in the infant mortality rate decreased while the inequality in its distribution by jurisdiction and the inequality associated with social conditions did not always accompany this reduction.

Dynamics and Distant Effects of Frontal/Temporal Epileptogenic Focus Using Functional Connectivity Maps.

OBJECTIVE: Connectivity patterns of interictal epileptiform discharges are all subtle indicators of where the three-dimensional (3D) source of a seizure could be located. These specific patterns are explored in the recorded electroencephalogram (EEG) signals of 20 individuals diagnosed with focal epilepsy to assess how their functional brain maps could be affected by the 3D onset of a seizure. METHODS: Functional connectivity maps, estimated by phase synchrony among EEG electrodes, were obtained by applying a data-driven recurrence-based method. This is augmented through a novel approach for selecting optimal parameters that produce connectivity matrices that are deemed significant for assessing epileptiform activity in context to the 3D source localization of seizure onset. These functional connectivity matrices were evaluated in different brain areas to gauge the regional effects of the 3D epileptic source. RESULTS: Empirical evaluations indicate high synchronization in the temporal and frontal areas of the effected epileptic hemisphere, whereas strong links connect the irritated area to frontal and temporal lobes of the opposite hemisphere. CONCLUSION: Epileptic activity originating in the temporal or frontal areas is seen to affect these areas in both hemispheres. SIGNIFICANCE: The results obtained express the dynamics of focal epilepsy in context to both the epileptogenic zone and the affected distant areas of the brain.

Implementación GPC EPOC en el primer nivel / Implementation of CPG COPD in the first level

INTRODUCCIÓN La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad prevenible y tratable. La Guía de Práctica Clínica Nacional de diagnóstico y tratamiento de la EPOC (GPC EPOC) fue realizada por el Ministerio de Salud de la Nación, con el propósito de facilitar al equipo de salud herramientas para detectar la enfermedad e instituir su tratamiento ambulatorio. OBJETIVOS El principal objetivo del presente estudio fue evaluar la implementación de la GPC EPOC en el primer nivel y los resultados en salud, así como evaluar la capacidad de los servicios, las barreras y facilitadores, efectividad de las intervenciones y la calidad de la atención. MÉTODOS Se llevó adelante un estudio de implementación. El diseño propuesto para el estudio fue "cuasi experimental ensayo comunitario de antes y después con grupo de comparación". En la práctica, no se pudo concretar el estudio antes y después por falta de tiempo y por el impacto de la pandemia de COVID-19 en la acción de los servicios, por lo que se realizó el estudio solo antes. RESULTADOS Se obtuvo información de relevamiento de 39 (81,3%) establecimientos participantes. Se verificó pocos especialistas y todos en los centros de referencia pero buena distribución de médicos generales y clínicos. De los médicos del primer nivel clínicos o generales, sólo 5,6% y 5,9% mencionaron haber recibido capacitación en espirometría y manejo de EPOC. Sólo 3 centros (6.9%), todos en Ushuaia, contaban con espirómetro, pero todos refirieron tener acceso y conocer el lugar de referencia. Existe amplia disposición de Broncodilatadores de Acción, pero pocos contaban con LABA o LAMA o combinación. Pocos además reflejaron acceso a medicación recomendada (18 de 43 ­ 41,8%). 46,5% y 65,1% relatan acceso a rehabilitación y terapia de cesación tabáquica respectivamente. Se refirieron 155 casos en el período de estudio, para confirmación y tratamiento en los niveles de referencia o se realizó directamente esto en el primer nivel. De los casos referidos, a 109 (70,3%) se les realizó la espirometría, y de estos, a 58 (56,3%) se les detectó EPOC. Entre los casos de EPOC detectados, sólo 8 (13,8%) tuvieron la enfermedad leve asintomática, 33 (56,9%) presentaron enfermedad sintomática con obstrucción no severa, y 17 (29,3%) fueron casos graves. CONCLUSIONES Según el estudio EPOCAR, la prevalencia de EPOC en población general de Argentina alcanzó un valor de 14,6%. Es posible concluir que la sospecha y detección que se realiza al impulsar la acción en el primer nivel, recupera casos adicionales que están llegando tarde y graves a la atención. La implementación de acciones para la detección y la atención de los casos de EPOC en el primer nivel es de altísima importancia para aumentar la capacidad de detección de los casos y la correcta atención de los mismos

[Result of a strategy using reminders before and after date of vaccination to improve timeliness of vaccination at six month]. / Resultado de una estrategia de recordatorios previos y posteriores a la fecha de vacunación para mejorar la oportunidad de la vacunación a los seis meses.

The impact of immunization depends on timely application of the vaccines, especially relevant in children. Successful strategies for improving timeliness include the use of nominalized records and follow-up mechanisms. This study assessed the result of reminders before and after the scheduled date of vaccination to improve timely vaccination at six months. A before-and-after intervention study was performed with a time series and comparator group with 1,856 children from Villa María, Córdoba, Argentina. The strategy was implemented in the city's public services and consisted of preparing weekly vaccination schedules, performing follow-up, and contacting and/or making active searches for no-show cases. Assessment of the result used the percentage of timely vaccination with the third dose of the pentavalent vaccine. Time series were built for each group, before and after, and were analyzed with a simple linear model. Means of the percentages were calculated with their confidence intervals, using bootstrap, and compared with the permutation method. In the intervention group, the mean percentage of timely vaccination increased significantly by 2.6 times, reaching 61.7% (56.2; 78.1). No significant increase occurred in the comparator group: p = 0.1101. The mean rates were similar before the implementation. Timely vaccination improved in children receiving the intervention. The results indicate that the proposed strategy to use nominalized records can reduce the delay in application of vaccines.

El impacto de la inmunización depende de que las vacunas se apliquen oportunamente, aspecto aún más relevante en los niños. Las estrategias exitosas para mejorar la oportunidad incluyen el uso de registros nominalizados y mecanismos de seguimiento. En este estudio se evaluó el resultado del uso de recordatorios previos, y posteriores a la fecha de vacunación, para mejorar la vacunación oportuna a los seis meses. Se realizó un estudio de intervención antes-después, con serie cronológica y grupo de comparación, con 1.856 niños de Villa María, Córdoba, Argentina. La estrategia se implementó en los servicios públicos de la ciudad y consistió en confeccionar agendas de vacunación semanalmente, realizar el seguimiento y contactar y/o realizar búsqueda activa en los casos de no concurrencia. Para evaluar el resultado se utilizó el porcentaje de vacunados oportunamente con tercera dosis de quíntuple. Se construyeron series cronológicas para cada grupo, antes y después, y se analizaron con un modelo lineal simple. Se calculó la media de los porcentajes y sus intervalos de confianza utilizando bootstrap y se compararon con el método de permutaciones. En el grupo de intervención, la media del porcentaje de vacunación oportuna aumentó significativamente 2,6 veces, llegando a 61,7% (56,2; 78,1). En el de comparación no hubo un incremento significativo: p = 0,1101. Antes de la implementación sus medias eran similares. Se mejoró la vacunación oportuna de los niños bajo intervención. Los resultados indican que la estrategia propuesta para utilizar los registros nominalizados puede reducir la demora en la aplicación de las vacunas.

O impacto da imunização depende de quais vacinas se aplicaram no momento oportuno, característica ainda mais relevante nas crianças. As estratégias bem sucedidas para melhorar a oportunidade incluem o uso de registros nominalizados e mecanismos de monitoramento. Neste estudo foi avaliado o resultado da utilização de avisos prévios, e posteriores a data de vacinação, para melhorar a vacinação num prazo de seis meses. Foi realizado um estudo de intervenção antes e depois, com série cronológica e grupo de comparação, com 1.856 crianças da Villa Maria, Córdoba, Argentina. A estratégia foi implementada nos serviços públicos da cidade e consistiu em elaborar agendas de vacinação semanalmente, fazer monitoramento, contatar e desenvolver uma pesquisa ativa nos casos de não concorrência. Para avaliar o resultado foi utilizada a porcentagem de vacinados adequadamente com a terceira dose de quíntupla. Foram construídas séries cronológicas para cada grupo, antes e depois, foram analisadas com um modelo lineal simples. Foi calculada a media das porcentagens e seus intervalos de confiança usando bootstrap e foram comparados com o método de permutações. No grupo de intervenção, a média de porcentagem de vacinação oportuna aumentou significativamente 2,6 vezes, chegando a 61,7% (56,2; 78,1). No grupo de comparação não ouve um incremento significativo: p = 0,1101. Antes da implementação as médias eram similares. Foi melhorada a vacinação oportuna das crianças sob intervenção. Os resultados indicam que a estratégia proposta para utilizar os registros nominalizados pode reduzir a demora nas aplicações das vacinas.

[Cross-sectional survey about the prevalence of allergic rhinitis in Argentina: Study PARA]. / Encuesta transversal sobre la prevalencia de rinitis alérgica en Argentina: el estudio PARA.

BACKGROUND: There are very few studies about the prevalence of allergic rhinitis in Argentina. OBJECTIVE: To determine the prevalence of allergic rhinitis in a population of inhabitants between the ages of 5 and 44 in Argentina. METHODS: A cross-sectional national study in which a self-reported questionnaire was used. The included participants are between the ages of 5 and 44 and they reside in urban areas. The information was collected by phone. RESULTS: 3200 participants were surveyed: 51.8% were women, 37.6% were between the ages of 5 and 19, and 62.4%, were between the ages of 20 and 44. The global prevalence of symptoms of allergic rhinitis was of 20.5%; the most frequent symptoms were sneezing (58.5%) and nasal congestion (51.4%). Overall, 44.3% of the participants had a family history of allergies. Allergic rhinitis was more frequent in women; the prevalence was of 22.3% in the group of participants between the ages of 5 and 19, and of 19.4% in the group of participants between the ages of 20 and 40 (p=0.0545); 63.8% of participants with symptoms did not have a medical diagnosis. CONCLUSIONS: The results of this first cross-sectional national survey have confirmed the high prevalence of self-reported symptoms of allergic rhinitis in adults and children in Argentina, particularly in women.

Antecedentes: Existen pocos estudios sobre la prevalencia de rinitis alérgica en Argentina. Objetivo: Determinar la prevalencia de rinitis alérgica en una población entre cinco y 44 años de edad en Argentina. Métodos: Estudio transversal nacional en el que se utilizó un cuestionario autoinformado. Se incluyeron participantes entre cinco y 44 años de edad residentes en áreas urbanas. La información se recolectó telefónicamente. Resultados: Se encuestaron 3200 participantes: 51.8 % del sexo femenino, 37.6 % tenía entre cinco y 19 años y 62.4 % entre 20 y 44 años. La prevalencia global de síntomas de rinitis alérgica fue de 20.5 %; los síntomas más frecuentes fueron los estornudos (58.5 %) y la congestión nasal (51.4 %). En general, 44.3 % de los participantes tenía antecedentes familiares de alergia. La rinitis alérgica fue más frecuente en las mujeres; la prevalencia fue de 22.3 % en el grupo de cinco a 19 años y de 19.4 % en el de 20 a 44 años (p = 0.0545); 63.8 % de los participantes con síntomas no tenía diagnóstico médico. Conclusiones: Los resultados de esta primera encuesta transversal nacional confirman la alta prevalencia de síntomas autoinformados de rinitis alérgica en adultos y niños en Argentina, especialmente en las mujeres.

Resultado de una estrategia de recordatorios previos y posteriores a la fecha de vacunación para mejorar la oportunidad de la vacunación a los seis meses / Result of a strategy using reminders before and after date of vaccination to improve timeliness of vaccination at six month / Resultado de uma estratégia de avisos prévios e posteriores a data de vacinação para melhorar a oportunidade da vacinação aos seis meses

Resumen: El impacto de la inmunización depende de que las vacunas se apliquen oportunamente, aspecto aún más relevante en los niños. Las estrategias exitosas para mejorar la oportunidad incluyen el uso de registros nominalizados y mecanismos de seguimiento. En este estudio se evaluó el resultado del uso de recordatorios previos, y posteriores a la fecha de vacunación, para mejorar la vacunación oportuna a los seis meses. Se realizó un estudio de intervención antes-después, con serie cronológica y grupo de comparación, con 1.856 niños de Villa María, Córdoba, Argentina. La estrategia se implementó en los servicios públicos de la ciudad y consistió en confeccionar agendas de vacunación semanalmente, realizar el seguimiento y contactar y/o realizar búsqueda activa en los casos de no concurrencia. Para evaluar el resultado se utilizó el porcentaje de vacunados oportunamente con tercera dosis de quíntuple. Se construyeron series cronológicas para cada grupo, antes y después, y se analizaron con un modelo lineal simple. Se calculó la media de los porcentajes y sus intervalos de confianza utilizando bootstrap y se compararon con el método de permutaciones. En el grupo de intervención, la media del porcentaje de vacunación oportuna aumentó significativamente 2,6 veces, llegando a 61,7% (56,2; 78,1). En el de comparación no hubo un incremento significativo: p = 0,1101. Antes de la implementación sus medias eran similares. Se mejoró la vacunación oportuna de los niños bajo intervención. Los resultados indican que la estrategia propuesta para utilizar los registros nominalizados puede reducir la demora en la aplicación de las vacunas.

Abstract: The impact of immunization depends on timely application of the vaccines, especially relevant in children. Successful strategies for improving timeliness include the use of nominalized records and follow-up mechanisms. This study assessed the result of reminders before and after the scheduled date of vaccination to improve timely vaccination at six months. A before-and-after intervention study was performed with a time series and comparator group with 1,856 children from Villa María, Córdoba, Argentina. The strategy was implemented in the city's public services and consisted of preparing weekly vaccination schedules, performing follow-up, and contacting and/or making active searches for no-show cases. Assessment of the result used the percentage of timely vaccination with the third dose of the pentavalent vaccine. Time series were built for each group, before and after, and were analyzed with a simple linear model. Means of the percentages were calculated with their confidence intervals, using bootstrap, and compared with the permutation method. In the intervention group, the mean percentage of timely vaccination increased significantly by 2.6 times, reaching 61.7% (56.2; 78.1). No significant increase occurred in the comparator group: p = 0.1101. The mean rates were similar before the implementation. Timely vaccination improved in children receiving the intervention. The results indicate that the proposed strategy to use nominalized records can reduce the delay in application of vaccines.

Resumo: O impacto da imunização depende de quais vacinas se aplicaram no momento oportuno, característica ainda mais relevante nas crianças. As estratégias bem sucedidas para melhorar a oportunidade incluem o uso de registros nominalizados e mecanismos de monitoramento. Neste estudo foi avaliado o resultado da utilização de avisos prévios, e posteriores a data de vacinação, para melhorar a vacinação num prazo de seis meses. Foi realizado um estudo de intervenção antes e depois, com série cronológica e grupo de comparação, com 1.856 crianças da Villa Maria, Córdoba, Argentina. A estratégia foi implementada nos serviços públicos da cidade e consistiu em elaborar agendas de vacinação semanalmente, fazer monitoramento, contatar e desenvolver uma pesquisa ativa nos casos de não concorrência. Para avaliar o resultado foi utilizada a porcentagem de vacinados adequadamente com a terceira dose de quíntupla. Foram construídas séries cronológicas para cada grupo, antes e depois, foram analisadas com um modelo lineal simples. Foi calculada a media das porcentagens e seus intervalos de confiança usando bootstrap e foram comparados com o método de permutações. No grupo de intervenção, a média de porcentagem de vacinação oportuna aumentou significativamente 2,6 vezes, chegando a 61,7% (56,2; 78,1). No grupo de comparação não ouve um incremento significativo: p = 0,1101. Antes da implementação as médias eram similares. Foi melhorada a vacinação oportuna das crianças sob intervenção. Os resultados indicam que a estratégia proposta para utilizar os registros nominalizados pode reduzir a demora nas aplicações das vacinas.

Prevalencia de enfermedad pulmonar obstructiva crónica en 6 aglomerados urbanos de Argentina: el estudio EPOC. AR / Prevalence of COPD in 6 Urban Clusters in Argentina: The EPOC. AR Study

Introducción: La prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) en Argentina no había sido estudiada. Objetivos: Determinar la prevalencia de EPOC y rasgos clínicos relevantes en una muestra representativa. Material y métodos: Estudio de corte transversal en población ≥40 años en 6 aglomerados urbanos seleccionada aleatoriamente mediante muestreo por conglomerados. Se aplicó una encuesta estructurada y espirometrías pre y postbroncodilatador (PBD). Se definió EPOC en quienes presentaban un cociente FEV1/FVC PBD<0,7. Se estimó la prevalencia total y para cada aglomerado con intervalo de confianza del 95% (IC). Resultados: Se realizaron 4.599 encuestas y 3.999 espirometrías, de las cuales 3.469 fueron útiles (86,8%). La prevalencia de EPOC fue de 14,5% (IC: 13,4-15,7). La distribución de los casos compatibles con EPOC según FEV1 (GOLD-2017) fue: 1: 38% (IC: 34-43); 2: 52% (IC: 47-56); 3: 10% (IC: 7-13); y 4: 1% (IC: 0,-2) y de acuerdo al modelo combinado ABCD (GOLD 2017): A: 52% (IC: 47-56); B: 43% (IC: 39-48); C: 1% (IC: 0-2) y D: 4% (IC: 2-6). El subdiagnóstico fue del 77,4% (IC 73,7-81,1%) y el error diagnóstico de 60,7% (IC 55,1-66,3%). Encontramos asociación significativa de presencia de EPOC con edad (OR 3,77 en 50-59 años a 19,23 en >80 años), sexo masculino (OR: 1,62; IC: 1,31-2), tabaquismo (OR: 1,95; IC: 1,49-2,54), nivel socieconómico bajo (OR: 1,33; IC: 1,02-1,73) y antecedentes de tuberculosis (OR: 3,3; IC: 1,43-7,62). Conclusiones: Se estima que más de 2,3 millones de argentinos padecen EPOC con elevada tasa de subdiagnóstico y error diagnóstico

Introduction: The prevalence of chronic obstructive pulmonary disease (COPD) has not been studied in Argentina. Objectives: To determine the prevalence and relevant clinical characteristics of COPD in a representative sample. Material and methods: We performed a cross-sectional study in a population of adults aged ≥ 40 years randomly selected by cluster sampling in 6 urban locations. Subjects answered a structured survey and performed pre- and post-bronchodilator spirometry (PBD). COPD was defined as FEV1/FVC ratio < 0.7 predicted value. The total prevalence was estimated for each cluster with its 95% confidence interval (CI). Results: Of 4,599 surveys and 3,999 spirometries, 3,469 were considered of adequate quality (86.8%) for our study. The prevalence of COPD was 14.5% (CI: 13.4-15.7). The distribution of COPD cases according to FEV1 (GOLD 2017) was stage 1: 38% (CI: 34-43); stage 2: 52% (CI: 47-56); stage 3: 10% (CI: 7-13); and stage 4: 1% (CI: 0-2), and according to the refined ABCD (GOLD 2017) assessment: A: 52% (CI: 47-56); B: 43% (CI: 39-48); C: 1% (CI: 0-2); D: 4% (CI: 2-6). The rate of underdiagnosis was 77.4% (CI 73.7-81.1%) and diagnostic error 60.7% (CI 55.1-66.3%). A significant association was found between COPD and age (OR 3.77 in individuals 50-59 years of age and 19.23 in those > 80 years), male gender (OR 1.62; CI 1.31-2), smoking (OR 1.95; CI 1.49-2.54), low socioeconomic status (OR 1.33; CI 1.02-1.73), and previous tuberculosis (OR 3.3; CI 1.43-7.62). Conclusions: We estimate that more than 2.3 million Argentineans have COPD, with high rates of underdiagnosis and diagnostic error