The Chilean exposome-based system for ecosystems (CHiESS): a framework for national data integration and analytics platform.

The double burden of diseases and scarce resources in developing countries highlight the need to change the conceptualization of health problems and translational research. Contrary to the traditional paradigm focused on genetics, the exposome paradigm proposed in 2005 that complements the genome is an innovative theory. It involves a holistic approach to understanding the complexity of the interactions between the human being's environment throughout their life and health. This paper outlines a scalable framework for exposome research, integrating diverse data sources for comprehensive public health surveillance and policy support. The Chilean exposome-based system for ecosystems (CHiESS) project proposes a conceptual model based on the ecological and One Health approaches, and the development of a technological dynamic platform for exposome research, which leverages available administrative data routinely collected by national agencies, in clinical records, and by biobanks. CHiESS considers a multilevel exposure for exposome operationalization, including the ecosystem, community, population, and individual levels. CHiESS will include four consecutive stages for development into an informatic platform: (1) environmental data integration and harmonization system, (2) clinical and omics data integration, (3) advanced analytical algorithm development, and (4) visualization interface development and targeted population-based cohort recruitment. The CHiESS platform aims to integrate and harmonize available secondary administrative data and provide a complete geospatial mapping of the external exposome. Additionally, it aims to analyze complex interactions between environmental stressors of the ecosystem and molecular processes of the human being and their effect on human health. Moreover, by identifying exposome-based hotspots, CHiESS allows the targeted and efficient recruitment of population-based cohorts for translational research and impact evaluation. Utilizing advanced technologies such as Artificial Intelligence (AI), Internet of Things (IoT), and blockchain, this framework enhances data security, real-time monitoring, and predictive analytics. The CHiESS model is adaptable for international use, promoting global health collaboration and supporting sustainable development goals.

Acute activation of hemichannels by ethanol leads to Ca2+-dependent gliotransmitter release in astrocytes.

Multiple studies have demonstrated that acute ethanol consumption alters brain function and cognition. Nevertheless, the mechanisms underlying this phenomenon remain poorly understood. Astrocyte-mediated gliotransmission is crucial for hippocampal plasticity, and recently, the opening of hemichannels has been found to play a relevant role in this process. Hemichannels are plasma membrane channels composed of six connexins or seven pannexins, respectively, that oligomerize around a central pore. They serve as ionic and molecular exchange conduits between the cytoplasm and extracellular milieu, allowing the release of various paracrine substances, such as ATP, D-serine, and glutamate, and the entry of ions and other substances, such as Ca2+ and glucose. The persistent and exacerbated opening of hemichannels has been associated with the pathogenesis and progression of several brain diseases for at least three mechanisms. The uncontrolled activity of these channels could favor the collapse of ionic gradients and osmotic balance, the release of toxic levels of ATP or glutamate, cell swelling and plasma membrane breakdown and intracellular Ca2+ overload. Here, we evaluated whether acute ethanol exposure affects the activity of astrocyte hemichannels and the possible repercussions of this phenomenon on cytoplasmatic Ca2+ signaling and gliotransmitter release. Acute ethanol exposure triggered the rapid activation of connexin43 and pannexin1 hemichannels in astrocytes, as measured by time-lapse recordings of ethidium uptake. This heightened activity derived from a rapid rise in [Ca2+]i linked to extracellular Ca2+ influx and IP3-evoked Ca2+ release from intracellular Ca2+ stores. Relevantly, the acute ethanol-induced activation of hemichannels contributed to a persistent secondary increase in [Ca2+]i. The [Ca2+]i-dependent activation of hemichannels elicited by ethanol caused the increased release of ATP and glutamate in astroglial cultures and brain slices. Our findings offer fresh perspectives on the potential mechanisms behind acute alcohol-induced brain abnormalities and propose targeting connexin43 and pannexin1 hemichannels in astrocytes as a promising avenue to prevent deleterious consequences of alcohol consumption.

Telemedicine in HIV health care during the COVID-19 pandemic: An implementation research study in Buenos Aires, Argentina.

BACKGROUND: From October 2020 to October 2022, we conducted an implementation study to offer telemedicine (TM) across four HIV units of general public hospitals in Buenos Aires. The intervention used TM to provide a continuum of care to patients with HIV. METHODS AND SETTING: We used the RE-AIM framework to evaluate the strategy. The study started during a COVID-19 outbreak with strict lockdown policies and continued until return to normal practices. Implementation facilitation served as the core implementation strategy. RESULTS: We reached 4118 patients (58% of eligible individuals), and the main perceived benefits were the ability to avoid exposure to infectious diseases and reduced travel time and cost. After a median of 515 days of follow-up, 95.7% of participants with HIV were receiving antiretroviral therapy, and 87.8% were virally suppressed, with a median CD4+ count of 648 cells/µL. In total, 36.6% reported clinical events, and 20.4% presented with COVID-19 infection. The proportion of physicians adopting TM was 69.37%. After enrolment, 2406 of 5640 (43%) follow-up visits were conducted via TM. By the end of the study, 26.29% of appointments offered in the four centres were through TM, whereas 73.71% were in-person appointments. CONCLUSION: It was feasible to implement TM in the four centres in the public health sector in Buenos Aires, Argentina. It was acceptable for both patients and healthcare workers, and effectively reached a large proportion of the population served in these clinics. Both healthcare workers and patients consider it a model of care that will continue to be offered in the future.

Association between environmental gradient of anthropization and phenotypic plasticity in two species of triatomines.

BACKGROUND: Triatoma garciabesi and T. guasayana are considered secondary vectors of Trypanosoma cruzi and frequently invade rural houses in central Argentina. Wing and head structures determine the ability of triatomines to disperse. Environmental changes exert selective pressures on populations of both species, promoting changes in these structures that could have consequences for flight dispersal. The aim of this study was to investigate the relationship between a gradient of anthropization and phenotypic plasticity in flight-related traits. METHODS: The research was carried out in Cruz del Eje and Ischilín departments (Córdoba, Argentina) and included 423 individuals of the two species of triatomines. To measure the degree of anthropization, a thematic map was constructed using supervised classification, from which seven landscapes were selected, and nine landscape metrics were extracted and used in a hierarchical analysis. To determine the flight capacity and the invasion of dwellings at different levels of anthropization for both species, entomological indices were calculated. Digital images of the body, head and wings were used to measure linear and geometric morphometric variables related to flight dispersion. One-way ANOVA and canonical variate analysis (CVA) were used to analyze differences in size and shape between levels of anthropization. Procrustes variance of shape was calculated to analyze differences in phenotypic variation in heads and wings. RESULTS: Hierarchical analysis was used to classify the landscapes into three levels of anthropization: high, intermediate and low. The dispersal index for both species yielded similar results across the anthropization gradient. However, in less anthropized landscapes, the density index was higher for T. garciabesi. Additionally, in highly anthropized landscapes, females and males of both species exhibited reduced numbers. Regarding phenotypic changes, the size of body, head and wings of T. garciabesi captured in the most anthropized landscapes was greater than for those captured in less anthropized landscapes. No differences in body size were observed in T. guasayana collected in the different landscapes. However, males from highly anthropized landscapes had smaller heads and wings than those captured in less anthropized landscapes. Both wing and head shapes varied between less and more anthropogenic environments in both species. CONCLUSIONS: Results of the study indicate that the flight-dispersal characteristics of T. garciabesi and T. guasayana changed in response to varying degrees of anthropization.

Cx43 hemichannels and panx1 channels contribute to ethanol-induced astrocyte dysfunction and damage.

BACKGROUND: Alcohol, a widely abused drug, significantly diminishes life quality, causing chronic diseases and psychiatric issues, with severe health, societal, and economic repercussions. Previously, we demonstrated that non-voluntary alcohol consumption increases the opening of Cx43 hemichannels and Panx1 channels in astrocytes from adolescent rats. However, whether ethanol directly affects astroglial hemichannels and, if so, how this impacts the function and survival of astrocytes remains to be elucidated. RESULTS: Clinically relevant concentrations of ethanol boost the opening of Cx43 hemichannels and Panx1 channels in mouse cortical astrocytes, resulting in the release of ATP and glutamate. The activation of these large-pore channels is dependent on Toll-like receptor 4, P2X7 receptors, IL-1ß and TNF-α signaling, p38 mitogen-activated protein kinase, and inducible nitric oxide (NO) synthase. Notably, the ethanol-induced opening of Cx43 hemichannels and Panx1 channels leads to alterations in cytokine secretion, NO production, gliotransmitter release, and astrocyte reactivity, ultimately impacting survival. CONCLUSION: Our study reveals a new mechanism by which ethanol impairs astrocyte function, involving the sequential stimulation of inflammatory pathways that further increase the opening of Cx43 hemichannels and Panx1 channels. We hypothesize that targeting astroglial hemichannels could be a promising pharmacological approach to preserve astrocyte function and synaptic plasticity during the progression of various alcohol use disorders.

Relationship between genetic diversity and morpho-functional characteristics of flight-related traits in Triatoma garciabesi (Hemiptera: Reduviidae).

BACKGROUND: Triatoma garciabesi, a potential vector of the parasitic protozoan Trypanosoma cruzi, which is the causative agent of Chagas disease, is common in peridomestic and wild environments and found throughout northwestern and central Argentina, western Paraguay and the Bolivian Chaco. Genetic differentiation of a species across its range can help to understand dispersal patterns and connectivity between habitats. Dispersal by flight is considered to be the main active dispersal strategy used by triatomines. In particular, the morphological structure of the hemelytra is associated with their function. The aim of this study was to understand how genetic diversity is structured, how morphological variation of dispersal-related traits varies with genetic diversity and how the morphological characteristics of dispersal-related traits may explain the current distribution of genetic lineages in this species. METHODS: Males from 24 populations of T. garciabesi across its distribution range were examined. The cytochrome c oxidase I gene (coI) was used for genetic diversity analyses. A geometric morphometric method based on landmarks was used for morpho-functional analysis of the hemelytra. Centroid size (CS) and shape of the forewing, and contour of both parts of the forewing, the head and the pronotum were characterised. Length and area of the forewing were measured to estimate the aspect ratio. RESULTS: The morphometric and phylogenetic analysis identified two distinct lineages, namely the Eastern and Western lineages, which coincide with different ecological regions. The Eastern lineage is found exclusively in the eastern region of Argentina (Chaco and Formosa provinces), whereas the Western lineage is prevalent in the rest of the geographical range of the species. CS, shape and aspect ratio of the hemelytra differed between lineages. The stiff portion of the forewing was more developed in the Eastern lineage. The shape of both portions of the hemelytra were significantly different between lineages, and the shape of the head and pronotum differed between lineages. CONCLUSIONS: The results provide preliminary insights into the evolution and diversification of T. garciabesi. Variation in the forewing, pronotum and head is congruent with genetic divergence. Consistent with genetic divergence, morphometry variation was clustered according to lineages, with congruent variation in the size and shape of the forewing, pronotum and head.

The antiseizure medication valproate increases hemichannel activity found in brain cells, which could worsen disease outcomes.

Glial cells play relevant roles in neuroinflammation caused by epilepsy. Elevated hemichannel (HC) activity formed by connexins (Cxs) or pannexin1 (Panx1) largely explains brain dysfunctions commonly caused by neuroinflammation. Glia express HCs formed by Cxs 43, 30, or 26, while glia and neurons both express HCs formed by Panx1. Cx43 HCs allow for the influx of Ca2+, which promotes glial reactivity, enabling the release of the gliotransmitters that contribute to neuronal over-stimulation. Valproate (VPA), an antiseizure medication, has pleiotropic actions on neuronal molecular targets, and their action on glial cell HCs remains elusive. We used HeLa cells transfected with Cx43, Cx30, Cx26, or Panx1 to determine the effect of VPA on HC activity in the brain. VPA slightly increased HC activity under basal conditions, but significantly enhanced it in cells pre-exposed to conditions that promoted HC activity. Furthermore, VPA increased ATP release through Cx43 HCs. The increased HC activity caused by VPA was resistant to washout, being consistent with in silico studies, which predicted the binding site for VPA and Cx43, as well as for Panx1 HCs on the intracellular side, suggesting that VPA first enters through HCs, after which their activity increases.

Vaccination impact: mortality and time shift to COVID-19 maximum severity in hospitalized patients. An Argentine multicenter registry.

INTRODUCTION: The COVID-19 vaccine became an effective instrument to prevent severe SARS-CoV-2 infections. However, 5% of vaccinated patients will have moderate or severe disease. OBJECTIVE: to compare mortality and days between the symptom onset to the peak disease severity, in vaccinated vs. unvaccinated COVID-19 hospitalized patients. METHODS: Retrospective observational study in 36 hospitals in Argentina. COVID-19 adults admitted to general wards between January 1, 2021, and May 31, 2022 were included. Days between symptoms onset to peak of severity were compared between vaccinated vs. unvaccinated patients with Cox regression, adjusted by Propensity Score Matching (PSM). Results in patients with one and two doses were also compared. RESULTS: A total of 3663 patients were included (3001 [81.9%] unvaccinated and 662 [18%] vaccinated). Time from symptom onset to peak severity was 7 days (IQR 4-12) vs. 7 days (IQR 4-11) in unvaccinated and vaccinated. In crude Cox regression analysis and matched population, no significant differences were observed. Regarding mortality, a Risk Ratio (RR) of 1.51 (IC95% 1.29-1.77) was observed in vaccinated patients, but in the PSM cohort, the RR was 0.73 (IC95% 0.60-0.88). RR in patients with one COVID-19 vaccine dose in PSM adjusted population was 0.7 (IC95% 0.45-1.03), and with two doses 0.6 (IC95% 0.46-0.79). DISCUSSION: The time elapsed between the onset of COVID-19 symptoms to the highest severity was similar in vaccinated and unvaccinated patients. However, hospitalized vaccinated patients had a lower risk of mortality than unvaccinated patients.

Introducción: A pesar de la eficacia de la vacuna contra el COVID-19 el 5% de los pacientes vacunados presentaran una enfermedad moderada o grave. El objetivo del presente estudio fue comparar los días entre el inicio de los síntomas y la gravedad máxima de la enfermedad, en pacientes con COVID-19 vacunados vs. no vacunados. Métodos: Estudio observacional retrospectivo en 36 hospitales de Argentina. Se incluyeron adultos con COVID-19 hospitalizados entre el 1/01/2021 y 31/5/2022. Se recolectaron datos demográficos, comorbilidades y progresión clínica de la enfermedad. Se compararon los días entre el inicio de los síntomas y el pico de gravedad entre vacunados y no vacunados mediante regresión de Cox, ajustada por emparejamiento por Propensity Score Matching (PSM). En un análisis de subgrupos, se compararon los resultados en pacientes con una y dos dosis de vacuna. Resultados: Se incluyeron 3663 pacientes (3001 [81.9%] no vacunados y 662 [18%] vacunados). El tiempo transcurrido desde el inicio de los síntomas hasta el pico de gravedad fue de 7 días (IQR 4 - 12) en no vacunados, y de 7 días (IQR 4-11) en vacunados. Tanto en el análisis de regresión de Cox crudo como en el ajustado, no se observaron diferencias significativas entre ambos grupos (HR ajustado 1.08 [IC 95% 0.82-1.4; p = 0.56]). En cuanto a la mortalidad, el Riesgo Relativo (RR) fue 1.51 (IC95% 1.29-1.77) en los pacientes vacunados, pero en la cohorte ajustada por Propensity Score, el RR fue de 0.73 (IC95% 0.60-0.88). El RR en el grupo con una dosis de vacuna COVID-19 en el análisis PSM fue 0.7 (IC95% 0.45-1.03), y con dos dosis 0.6 (IC95% 0.46-0.79). Discusión: El tiempo entre el inicio de los síntomas de COVID-19 y el pico de severidad fue igual en vacunados y no vacunados. Sin embargo, los pacientes vacunados hospitalizados presentaron menor mortalidad tras el ajuste por confundidores.

Consultas tardías en los servicios de emergencias pediátricas durante la pandemia por COVID-19 en Uruguay, entre el 13 de marzo y el 29 de julio de 2020 / Delayed visits to Pediatric Emergency Departments during the COVID-19 pandemic in Uruguay between March 13 and July 29, 2020 / Consultas tardias nos Serviços de Emergência Pediátrica durante a pandemia de COVID-19 no Uruguai entre 13 de março e 29 de julho de 2020

En diciembre de 2019, en Wuhan, China, se detectaron los primeros casos de SARS-CoV-2. En Uruguay, desde el 16 de marzo de 2020 se suspendieron las actividades de enseñanza, deportivas y espectáculos públicos. Varios países reportaron una marcada disminución de las visitas a urgencias. Algunos niños presentaron enfermedades ocasionales o descompensaciones de enfermedades crónicas, consultando en forma tardía con el riesgo que ello implica. El objetivo de este trabajo es realizar una descripción de las consultas tardías durante la pandemia. Se realizó un estudio multicéntrico y descriptivo entre el 13 de marzo y el 29 de julio de 2020. Se definió consulta tardía como los ingresos por injurias agudas con más de 6 horas de evolución, fiebre mayor a 72 horas de evolución, dificultad respiratoria con más de 12 horas de evolución, síntomas agudos, como dolor abdominal, de más de 24 horas de evolución, síntomas de más de 12 horas de evolución en niños con enfermedades crónicas que determinaron descompensación e ingreso. Se incluyeron 27 centros. Se registraron un total de 34.260 consultas en urgencia, se incluyeron 189 niños para el estudio. El promedio de edad fue de 6 años; 17 pacientes requirieron ingreso a unidad de cuidados intensivos (UCI). Predominó la apendicitis entre los diagnósticos al alta. Esta investigación puso en evidencia la existencia de consultas tardías en nuestro país. Esto contribuye a ponderar el impacto negativo de la pandemia en la población pediátrica.

In December 2019, the first cases of SARS-CoV-2 were detected in Wuhan. In Uruguay, since March 16, teaching, sports and public entertainment activities were suspended. Several countries reported a marked decrease in emergency room visits. Some children presented occasional illnesses or decompensations from chronic illnesses, consulting late with the risk that this implies. The objective of the work is to make a description of late consultations during the pandemic. A multicenter and descriptive study was carried out between March 13 and July 29, 2020. "Late consultation" was defined as admissions for: Acute injuries with more than 6 hours of evolution, fever greater than 72 hours of evolution, difficulty respiratory disease with more than 12 hours of evolution, acute symptoms such as abdominal pain of more than 24 hours of evolution, symptoms of more than 12 hours of evolution in children with chronic diseases that determined decompensation and admission. 27 centers were included. A total of 34260 emergency consultations were registered, 189 children were included for the study. The average age was 6 years. 17 patients required admission to the ICU. Appendicitis predominated among the diagnoses at discharge. This research revealed the existence of late consultations in our country. This helps to weigh the negative impact of the pandemic on the pediatric population.

Em dezembro de 2019, em Wuhan, foram detectados os primeiros casos de SARS-CoV-2. No Uruguai, desde 16 de março, as atividades de ensino, esporte e entretenimento público foram suspensas. Vários países relataram uma diminuição acentuada nas visitas ao pronto-socorro. Algumas crianças apresentavam doenças ocasionais ou descompensações de doenças crônicas, consultando tardiamente os riscos que isso implica. O objetivo do trabalho é fazer uma descrição das consultas tardias durante a pandemia. Um estudo multicêntrico e descritivo foi realizado entre 13 de março e 29 de julho de 2020. Consulta tardia foi definida como internações por: Lesões agudas com mais de 6 horas de evolução, febre maior que 72 horas de evolução, dificuldade respiratória com mais de 12 horas de evolução, sintomas agudos como dor abdominal com mais de 24 horas de evolução, sintomas com mais de 12 horas de evolução em crianças com doenças crônicas que determinaram descompensação e internação. 26 centros foram incluídos. Um total de 34.260 consultas de emergência foram registradas, 189 crianças foram incluídas no estudo. A idade média era de 6 anos. 17 pacientes necessitaram de internação na UTI. Apendicite predominou entre os diagnósticos na alta. Esta pesquisa revelou a existência de consultas tardias em nosso país. Isso ajuda a pesar o impacto negativo da pandemia na população pediátrica.

Vaccination impact: mortality and time shift to Covid-19 maximum severity in hospitalized patients - An Argentine multicenter registry / Mortalidad y tiempo entre el inicio y máxima gravedad de COVID-19, en pacientes hospitalizados vacunados y no vacunados. Registro multicéntrico argentino

Abstract Introduction : The COVID-19 vaccine became an effec tive instrument to prevent severe SARS-CoV-2 infections. However, 5% of vaccinated patients will have moderate or severe disease. Objective: to compare mortality and days between the symptom onset to the peak disease severity, in vaccinated vs. unvaccinated COVID-19 hos pitalized patients. Methods : Retrospective observational study in 36 hospitals in Argentina. COVID-19 adults admitted to general wards between January 1, 2021, and May 31, 2022 were included. Days between symptoms onset to peak of severity were compared between vaccinated vs. unvaccinated patients with Cox regression, adjusted by Propensity Score Matching (PSM). Results in patients with one and two doses were also compared. Results : A total of 3663 patients were included (3001 [81.9%] unvaccinated and 662 [18%] vaccinated). Time from symptom onset to peak severity was 7 days (IQR 4-12) vs. 7 days (IQR 4-11) in unvaccinated and vacci nated. In crude Cox regression analysis and matched population, no significant differences were observed. Regarding mortality, a Risk Ratio (RR) of 1.51 (IC95% 1.29-1.77) was observed in vaccinated patients, but in the PSM cohort, the RR was 0.73 (IC95% 0.60-0.88). RR in patients with one COVID-19 vaccine dose in PSM adjusted population was 0.7 (IC95% 0.45-1.03), and with two doses 0.6 (IC95% 0.46-0.79). Discussion : The time elapsed between the onset of COVID-19 symptoms to the highest severity was simi lar in vaccinated and unvaccinated patients. However, hospitalized vaccinated patients had a lower risk of mortality than unvaccinated patients.

Resumen Introducción : A pesar de la eficacia de la vacuna contra el COVID-19 el 5% de los pacientes vacunados presentaran una enfermedad moderada o grave. El ob jetivo del presente estudio fue comparar los días entre el inicio de los síntomas y la gravedad máxima de la enfermedad, en pacientes con COVID-19 vacunados vs. no vacunados. Métodos : Estudio observacional retrospectivo en 36 hospitales de Argentina. Se incluyeron adultos con CO VID-19 hospitalizados entre el 1/01/2021 y 31/5/2022. Se recolectaron datos demográficos, comorbilidades y progresión clínica de la enfermedad. Se compararon los días entre el inicio de los síntomas y el pico de gravedad entre vacunados y no vacunados mediante regresión de Cox, ajustada por emparejamiento por Propensity Score Matching (PSM). En un análisis de subgrupos, se compararon los resultados en pacientes con una y dos dosis de vacuna. Resultados : Se incluyeron 3663 pacientes (3001 [81.9%] no vacunados y 662 [18%] vacunados). El tiempo transcurrido desde el inicio de los síntomas hasta el pico de gravedad fue de 7 días (IQR 4 - 12) en no vacunados, y de 7 días (IQR 4-11) en vacunados. Tanto en el análisis de regresión de Cox crudo como en el ajustado, no se observaron diferencias significativas entre ambos grupos (HR ajustado 1.08 [IC 95% 0.82-1.4; p = 0.56]). En cuanto a la mortalidad, el Riesgo Relativo (RR) fue 1.51 (IC95% 1.29-1.77) en los pacientes vacunados, pero en la cohorte ajustada por Propensity Score, el RR fue de 0.73 (IC95% 0.60-0.88). El RR en el grupo con una dosis de vacuna COVID-19 en el análisis PSM fue 0.7 (IC95% 0.45-1.03), y con dos dosis 0.6 (IC95% 0.46-0.79). Discusión : El tiempo entre el inicio de los síntomas de COVID-19 y el pico de severidad fue igual en vacu nados y no vacunados. Sin embargo, los pacientes va cunados hospitalizados presentaron menor mortalidad tras el ajuste por confundidores.

Cx43 hemichannels and panx1 channels contribute to ethanol-induced astrocyte dysfunction and damage

Background Alcohol, a widely abused drug, significantly diminishes life quality, causing chronic diseases and psychiatric issues, with severe health, societal, and economic repercussions. Previously, we demonstrated that non-voluntary alcohol consumption increases the opening of Cx43 hemichannels and Panx1 channels in astrocytes from adolescent rats. However, whether ethanol directly affects astroglial hemichannels and, if so, how this impacts the function and survival of astrocytes remains to be elucidated. Results Clinically relevant concentrations of ethanol boost the opening of Cx43 hemichannels and Panx1 channels in mouse cortical astrocytes, resulting in the release of ATP and glutamate. The activation of these large-pore channels is dependent on Toll-like receptor 4, P2X7 receptors, IL-1β and TNF-α signaling, p38 mitogen-activated protein kinase, and inducible nitric oxide (NO) synthase. Notably, the ethanol-induced opening of Cx43 hemichannels and Panx1 channels leads to alterations in cytokine secretion, NO production, gliotransmitter release, and astrocyte reactivity, ultimately impacting survival. Conclusion Our study reveals a new mechanism by which ethanol impairs astrocyte function, involving the sequential stimulation of inflammatory pathways that further increase the opening of Cx43 hemichannels and Panx1 channels. We hypothesize that targeting astroglial hemichannels could be a promising pharmacological approach to preserve astrocyte function and synaptic plasticity during the progression of various alcohol use disorders.

Descriptive Epidemiology of Melanoma Diagnosed between 2010 and 2014 in a Colombian Cancer Registry and a Call for Improving Available Data on Melanoma in Latin America.

We aimed to improve the available information on morphology and stage for cutaneous melanoma in the population-based cancer registry of the Bucaramanga Metropolitan Area in Colombia. The incidence and survival rates and the distribution of melanoma patients by age, gender, anatomical subsite, and histological subtype were calculated. All 113 melanoma patients (median age 61) were followed up (median time 7.4 years). This exercise (filling in missing information in the registry by manual search of patient clinical record and other available information) yielded more identified invasive melanomas and cases with complete information on anatomical localization and stage. Age-standardized incidence and mortality rates were 1.86 and 1.08, being slightly higher for males. Most melanomas were localized on the lower limbs, followed by the trunk. For 35% of all melanomas, the morphological subtype remained unknown. Most of the remaining melanomas were nodular and acral lentiginous melanomas. Overall global and relative 5-year survival was 61.6% and 71.3%, respectively, with poorer survival for males than females. Melanomas on the head and neck and unspecified anatomical sites had the worst survival. Patients without stage information in their medical files had excellent survival, unlike patients for whom medical files were no longer available. This study shows the possibility of improving data availability and the importance of good quality population-based data.

A realistic situation, proposed from data generated within the GeOrder Simulator to elicit the statistical reasoning.

Construction and handling of important statistical concepts, such as statistical estimators computing, or organization of data in graphs and tables, are oftenly taught in a strict algorithmic manner. As consequence, students abilities regarding experimentation, data sampling, data collecting, data organization and results interpretation, are limited and their solutions lack of statistical sustain. In this work, in study class consisting in students of the Logistic and Transport Engineering program, it is developed and implemented a realistic problem situation: a sales e-commerce company has to decide, by analyzing received orders, whether to implement its own delivery system or hire a third-party delivery company. The software GeOrder Simulator is employed to generate random data for weight and location of simulated orders and the data are presented to students in tabular and iconic, onto a map geolocation, semiotic representation registers. The research aim of this work, is to analyze, from the perspective of Semiotic Representation Theory, the effect onto the statistical reasoning that is provoked in students when they solve the realistic problem situation with the data generated by the GeOrder Simulator. The results show that the addressing of the realistic problem situation together with the usage of the GeOrder Simulator, elicited the statistical reasoning in the students since it is observed the integration of statistical concepts within their argumentation, by means of the coordination of tabular, graphical and numerical semiotic representation registers.

Antagonistic effects of grazers and shrubs on the emergence and establishment of seedlings in a sub-humid grassland of South America.

Biotic interactions are key processes that strongly affect the performance of seedlings in plant communities. In this work, we evaluated the effect of grazing and shrubs on the emergence and establishment of seedlings with different life-forms (dicotyledonous and monocotyledonous) in a sub-humid grassland community. We delimited five areas of 25 m2 in which we established four permanent plots of 1.0 m2. Two plots were centered at shrubs (beneath the canopy) and two in open spaces (without shrubs). Half of the shrubs and open plots were fenced to avoid grazing. During two consecutive years we marked all emerged seedlings and followed their fate. Grazing promoted dicotyledonous seedling emergence but reduced establishment. On the contrary, shrubs reduced dicotyledonous emergence but enhanced establishment. We did not detect any effect of shrubs or grazing on the emergence of monocotyledonous seedlings. Most seedlings emerged during fall and winter and died during spring and summer. Recruitment from seeds in this grassland is rare and complex, involving biotic and abiotic factors, with different responses to grazing and shrubs depending on seedling life-form and ontogeny.

Bioseguridad en ambientes quirúrgicos durante la COVID-19 / Biosafety in Surgical Environments during the COVID-19 Pandemic

Introducción: La COVID-19 significó un gran reto para los servicios de cirugía a nivel mundial, lo que trajo como consecuencia modificaciones, incluso la suspensión de la actividad quirúrgica en algunos casos con el objetivo de garantizar seguridad tanto para el paciente como para el personal de salud. Objetivo: Describir acciones que contribuyan a garantizar condiciones de bioseguridad en ambientes quirúrgicos durante la pandemia de COVID-19. Métodos: Se realizó una revisión bibliográfica para la cual se usaron 37 referencias bibliográficas en inglés y español. Se consultaron fuentes científicas como PubMed/Medline, SciELO, Scopus, ScienceDirect y fuentes oficiales como la Organización Mundial de la Salud. Desarrollo: Ante la reanudación de la cirugía electiva se crearon protocolos de actuación. Deben clasificarse los pacientes en 3 grupos según la posibilidad de padecer COVID-19: individuos sanos, portadores asintomáticos y pacientes con síntomas. Además, debe darse prioridad a los pacientes cuyos procedimientos fueron cancelados. Se preconiza crear circuitos independientes y separados para evitar el contacto de casos sospechosos o confirmados de COVID-19 con el resto de pacientes. Para garantizar mayor seguridad debe entrenarse al personal médico en la forma correcta de utilizar los medios de protección personal. La inducción anestésica de estos pacientes debe garantizar su seguridad y prevenir el contagio. Una vez concluida la cirugía, se llevará a cabo la recuperación inicial del paciente dentro del propio quirófano y este será higienizado estrictamente. Conclusiones: Los profesionales sanitarios deben estar adecuadamente entrenados y conocer las medidas de bioseguridad y protocolos sanitarios tanto del hospital como del país en que se encuentren(AU)

Introduction: COVID-19 posed a great challenge to surgical services worldwide, resulting in modifications, including the suspension of surgical activity in some cases with the aim of ensuring safety for both the patient and the health personnel. Objective: To describe actions that contribute to guarantee biosafety conditions in surgical environments during the COVID-19 pandemic. Methods: A bibliographic review was carried out using 37 bibliographic references in English and Spanish. Scientific sources, such as PubMed/Medline, SciELO, Scopus and ScienceDirect, were consulted; as well as official sources, such as the World Health Organization. Development: When elective surgery was resumed, action protocols were created. Patients should be classified into 3 groups, according to the possibility of having COVID-19: healthy individuals, asymptomatic carriers, and patients with symptoms. In addition, priority should be given to patients whose procedures have been cancelled. Independent and isolated wards are recommended to be created in order to avoid contact between suspected or confirmed COVID-19 cases and the rest of the patients. To ensure greater safety, the medical personnel should be trained in the correct use of personal protective equipment. The anesthetic induction of these patients should ensure their safety and prevent contagion. Once the surgery is over, the initial recovery of the patient will be carried out inside the operating room itself, which shall be strictly sanitized. Conclusions: Healthcare professionals must be adequately trained and be aware of the biosecurity measures and healthcare protocols of both the hospital and the country where they are located(AU)

Adopción/Adaptación mediante Comentario para Argentina por intermedio de la Federación Iberopanamericana de Periodoncia (FIPP) de la Guía de Práctica Clínica (GPC) de nivel S3: Tratamiento de la periodontitis en los estadios I ­ III, de la Federación Europea de Periodoncia (EFP), traducida por la Sociedad Española de Periodoncia (SEPA) / Adoption/Adaptation by Comment, for Argentina through the Iberopanamerican Federation of Periodontology (FIPP) of the S3 Level Clinical Practice Guideline (CPG): Treatment of periodontitis in stages I ­ III, of the European Federation of Periodontology (EFP), translated by the Spanish Society of Periodontics (SEPA)

La Sociedad Argentina de Periodoncia ha formulado un Comentario, analizando los condicionantes del contexto na- cional, para determinar si las recomendaciones generadas en la Guía de Práctica Clínica de nivel S3 de la Federación Eu- ropea de Periodoncia para el tratamiento de la periodontitis en estadios I-III, podrían ser aplicadas para dar respuesta a la demanda de la población, en lo referido a la salud periodontal (AU)

The Argentine Society of Periodontics has formulated a Commentary, analyzing the determining factors of the nation- al context, to determine if the recommendations generated in the Level S3 Clinical Practice Guideline of the European Fed- eration of Periodontics for the treatment of periodontitis in stages I-III could be applied to respond to the demand of the population, regarding periodontal health (AU)

Reasons for antiretroviral switching in Colombia: A retrospective cohort study.

INTRODUCTION: Long-term use of antiretroviral therapy (ART) for HIV infection might lead to the necessity of switching regimens. We aimed to analyze the reasons for the ART switch, the time-to-switch of ART, and its associated factors in a Colombian cohort. METHODS: We conducted a retrospective cohort in 20 HIV clinics, including participants ≥18 years old with confirmed HIV infection who underwent an ART switch from January 2017 to December 2019 with at least 6 months of follow-up. A time-to-event analysis and an exploratory Cox model were performed. RESULTS: 796 participants switched ART during the study period. The leading cause of ART switch was drug intolerance (n = 449; 56.4%) with a median time-to-switch of 12.2 months. The longest median time-to-switch was due to regimen simplification (42.4 months). People ≥50 years old (HR = 0.6; 95% CI (0.5-0.7) and CDC stage 3 at diagnosis (HR = 0.8; 95% CI (0.6-0.9) had less hazard for switching ART over time. CONCLUSIONS: In this Colombian cohort, drug intolerance was the main cause of the ART switch, and the time-to-switch is shorter than reports from other countries. In Colombia, it is crucial to apply current recommendations for ART initiation to choose regimens with a better tolerability profile.

Adopción/Adaptación mediante Comentario para Argentina por intermedio de la Federación Iberopanamericana de Periodoncia (FIPP) de la Guía de Práctica Clínica (GPC) de nivel S3: Tratamiento de la periodontitis en los estadios I - III, de la Federación Europea de Periodoncia (EFP), traducida por la Sociedad Española de Periodoncia (SEPA) / Adoption/Adaptation by Comment, for Argentina through the Iberopanamerican Federation of Periodontology (FIPP) of the S3 Level Clinical Practice Guideline (CPG): Treatment of periodontitis in stages I - III, of the European Federation of Periodontology (EFP), translated by the Spanish Society of Periodontics (SEPA)

Resumen La Sociedad Argentina de Periodoncia ha formulado un Comentario, analizando los condicionantes del contexto nacional, para determinar si las recomendaciones generadas en la Guía de Práctica Clínica de nivel S3 de la Federación Europea de Periodoncia para el tratamiento de la periodontitis en estadios I-III, podrían ser aplicadas para dar respuesta a la demanda de la población, en lo referido a la salud periodontal.

Abstract The Argentine Society of Periodontics has formulated a Commentary, analyzing the determining factors of the national context, to determine if the recommendations generated in the Level S3 Clinical Practice Guideline of the European Federation of Periodontics for the treatment of periodontitis in stages I-III could be applied to respond to the demand of the population, regarding periodontal health.

Long-Term Pediatric Outcomes of Decompressive Craniectomy after Severe Traumatic Brain Injury.

OBJECTIVE: There is no consensus on the use of decompressive craniectomy (DC) to manage severe traumatic brain injury (sTBI). We evaluated the profile of pediatric patients admitted with sTBI and assessed functional outcomes, 6 months posttrauma, in patients who had a DC and in those who had not, and the functional outcomes of early versus late DCs. PATIENTS AND METHODS: This case-control observational study evaluated pediatric patients admitted for sTBI in Puerto Rico (June 2016-October 2018); we included patients admitted within 24 hours of injury and had a Glasgow Coma Scale (GCS) of 8 or lower. 6-month post trauma outcomes were measured with the Glasgow Outcome Scale Extended Pediatric (GOS-E Peds). RESULTS: 20 patients were included; 15 underwent a DC and 5 comprised the control group. We found no differences in terms of sex, age, GCS score, Pediatric Risk of Mortality score, or Pediatric Trauma Score. However, in the DC group, a higher percentage of patients presented significant cerebral herniation in the initial computed tomography scan (CT) (DC: 73%; control: 0%; P = .005). No differences were found regarding intracranial pressure (ICP), cerebral perfusion pressure, mean arterial pressure, PaCO2, or temperature. Patients in the DC group had longer hospital stay (DC: 41; control: 17 days; P = .0005). All patients with DC survived, with an early procedure being associated with favorable outcomes. CONCLUSION: As determined 6 months post-trauma, this study showed that early DC increased survival and improved functionality.