Description of a single centre cohort of patients with systemic sclerosis from the University Hospital of Buenos Aires and factors associated with lung function deterioration. A retrospective study.

INTRODUCTION: Given the paucity of data in Latin America and especially in Argentina regarding the epidemiology of SSc, the prevalence of ILD, its course, and particularly the response to treatment, our objective was to evaluate a cohort of SSc patients evaluated in a single University Hospital in Buenos Aires. PATIENTS/METHODS: We included 152 patients with SSc, followed from disease onset to last pulmonary function test and with at least two PFT and up to 30 months between each. RESULTS: Sixty-one percent had diffuse SSc (DSSc) and 32% limited SSc (LSSc). The only significant clinical differences between these groups were a higher initial mRodnan score and prevalence of ILD in the DSSc. These also had significantly more anti Scl-70 (Topoisomerase 1) antibodies compared to the LSSC group who had significantly more anti centromere antibodies. The DSSc group also had significantly more extensive damage on HRCT with no differences in terms of imaging patterns. Comparing patients with and without ILD by HRCT, those with ILD had significantly more extensive damage, significantly more anti Scl-70 antibodies, and significantly fewer anti centromere antibodies than those without ILD. Patients whose ILD progressed had a smoking history (OR 4.97) and prior immunosuppressive treatment (OR 15.6) (multivariate analysis). Overall disease duration was significantly shorter in those who progressed. CONCLUSIONS: Our SSc population had similar characteristics to those described elsewhere as well as prevalence of ILD and its progression. We found a shorter disease duration, smoking, and prior immunosuppressive treatment to be associated with ILD progression.

Description of a single centre cohort of patients with systemic sclerosis from the University Hospital of Buenos Aires and factors associated with lung function deterioration. A retrospective study / Descripción de una cohorte de pacientes con esclerosis sistémica del Hospital de la Universidad de Buenos Aires y factores asociados al deterioro de la función pulmonar. Un estudio retrospectivo

Introduction: Given the paucity of data in Latin America and especially in Argentina regarding the epidemiology of SSc, the prevalence of ILD, its course, and particularly the response to treatment, our objective was to evaluate a cohort of SSc patients evaluated in a single University Hospital in Buenos Aires. Patients/Methods: We included 152 patients with SSc, followed from disease onset to last pulmonary function test and with at least two PFT and up to 30 months between each. Results: Sixty-one percent had diffuse SSc (DSSc) and 32% limited SSc (LSSc). The only significant clinical differences between these groups were a higher initial mRodnan score and prevalence of ILD in the DSSc. These also had significantly more anti Scl-70 (Topoisomerase 1) antibodies compared to the LSSC group who had significantly more anti centromere antibodies. The DSSc group also had significantly more extensive damage on HRCT with no differences in terms of imaging patterns. Comparing patients with and without ILD by HRCT, those with ILD had significantly more extensive damage, significantly more anti Scl-70 antibodies, and significantly fewer anti centromere antibodies than those without ILD. Patients whose ILD progressed had a smoking history (OR 4.97) and prior immunosuppressive treatment (OR 15.6) (multivariate analysis). Overall disease duration was significantly shorter in those who progressed. Conclusions: Our SSc population had similar characteristics to those described elsewhere as well as prevalence of ILD and its progression. We found a shorter disease duration, smoking, and prior immunosuppressive treatment to be associated with ILD progression.(AU)

Introducción: La escasez de datos en Latinoamérica, y especialmente en Argentina, sobre la epidemiología de la esclerosis sistémica (SSc), la prevalencia de enfermedad pulmonar intersticial (EPID) y su progresión, llevó a evaluar una cohorte de pacientes con SSc atendidos en un hospital universitario de Buenos Aires, Argentina. Pacientes/Métodos: Incluimos 152 pacientes con SSc, seguidos desde el inicio de la enfermedad hasta el último examen funcional respiratorio (EFR) y con por lo menos dos EFR separados por un mínimo de 30 meses. Resultados: El 61% tenían enfermedad difusa (DSSc) y el 32%, limitada (LSSc). Aquellos con DSSc tuvieron significativamente un mayor índice modificado de Rodnan y prevalencia de EPID. Estos también tuvieron significativamente más anticuerpos anti-Scl-70 (topoisomerasa 1) comparados con LSSc, quienes tuvieron significativamente más anticuerpos anti-centrómero. Aquellos con DSSc mostraron significativamente más daño en la tomografía computada de alta resolución (TACAR), pero sin diferencias respecto a patrón de imágenes. Aquellos con EPID por TACAR tuvieron significativamente más daño, más anticuerpos anti Scl-70 y menos anticuerpos anti-centrómero que aquellos sin EPID. La progresión de EPID (análisis multivariado) se relacionó con consumo de tabaco (OR: 4,97) y uso previo de inmunosupresores (OR: 15,6). La duración de la enfermedad fue menor en los que progresaron. Conclusiones:Nuestra población de SSc tuvo características similares a lo descripto en el resto del mundo, así como la prevalencia y la progresión de EPID. Encontramos una menor duración de enfermedad, el consumo de tabaco y el uso previo de inmunosupresores asociados a la progresión de EPID.(AU)

Comparing COVID-19 in the antipodes: Insights from pandemic containment strategies on both sides of the Pacific.

That the COVID-19 pandemic is unprecedented in terms of its scale, spread and shocks can be evinced by the myriad of ever-changing responses cities all around the world have rolled out throughout the different waves of outbreaks. Although the threat is similar across the world, it took some time before its reach became global and the waves of outbreak are experienced by cities at different times. While this staggered spread imply that some cities might manage the virus better as they learn from the experiences of cities which had been amongst the earliest to face the virus, the reality is more complicated. In the early stages of the pandemic, the global consensus on the best way to contain the virus swiftly converged in the interlinked strategies of restricting the movement of people and minimizing their social contact. However, the effectiveness of these strategies differ greatly between cities. To that end, this study focuses on COVID-19 responses in two regions (Latin America and Southeast Asia) and examines the evolution of the first wave of COVID-19 outbreaks during 2020 in Singapore, Jakarta (Indonesia), Bogotá (Colombia) and Santiago (Chile). The study is based on a comparative approach and uses a variety of data sources, namely morphology, density, housing concentration, mobility, and governance in the four analyzed cities. The goal is to shed light on the response of city governments in these two different regions in terms of mobility restrictions in order to reduce the cases of new infections. The results show the relevance of urban policies and their territorial approaches, particularly in terms of mobility and public transport networks in the four cities.

Accessibility and adherence to positive airway pressure treatment in patients with obstructive sleep apnea: a multicenter study in Latin America.

PURPOSE: Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America. METHODS: Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12-18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey. RESULTS: Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m2) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001). CONCLUSIONS: Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy.

Comorbidities among adults living with hiv from two healthcare centers in Colombia / Comorbilidad entre adultos viviendo con VIH en dos centros de atención en Colombia

Objective: To determine the prevalence of comorbidities among adults living with HIV from two healthcare centers in Colombia, and to identify factors associated with comorbidity-free years. Methods: Observational, retrospective medical chart review study. Summary statistics for demographic and clinical characteristics were developed and relationship between comorbidity-free years were analyzed through Kaplan-Meier analysis and Cox regression. Results: 669 clinical charts were included, 71.7% were male and 16.1% were 50 years or older, 69.96% had at least one comorbidity. The most frequent comorbidities were dislipidemia(15.06%), hypertension(5.67%), risk factors were tobacco use(15.33%), alcohol intake(24.36%) and drugs abuse (14.66%). Discussion: These findings are consistent with previous reports showing the underlying processes of patients, producing multiple comorbidities. Conclusions: Significant proportion of patients have comorbidities that may increase risk of other complications or reduced comorbidity-free years. Poly-pharmacy among HIV+ adults need to be addressed to ensure adherence and minimize drug-drug interactions.

Objetivo: Determinar la prevalencia de comorbilidades entre adultos viviendo con VIH en dos centros de atención en Colombia e identificar los factores asociados con años libres de comorbilidad . Metodos: Revisión observacional retrospectiva de historias clínicas. Resumen de estadísticas de características demográficas y clínicas y análisis de correlación entre características clínicas a través de pruebas de Kaplan-Meier y regresión de Cox. Resultados: Se analizaron 669 historias clínicas, 71.7% fueron hombres y 16.1% tuvieron 50 años o más, 69.96% tuvieron al menos una comorbilidad. Las comorbilidades más frecuentes fueron dislipidemia(15.06%), hipertensión (5.67%), los factores de riesgo fueron el uso de tabaco (15.33%), ingesta de alcohol (24.36%) y abuso de drogas (14.66%). Discusión: Estos hallazgos son consistentes con reportes previos que evidencian los procesos subyacentes que llevan a múltiples comorbilidades. Conclusiones: Una proporción significativa de pacientes tiene comorbilidades que pueden aumentar el riesgo de otras condiciones o los años libres de comorbilidad. La polifarmacia en pacientes HIV+ debe hacerse de manera que se asegure la adherencia y se minimicen las interacciones entre medicamentos.