The Lambda Variant in Argentina: Analyzing the Evolution and Spread of SARS-CoV-2 Lineage C.37.

The second wave of COVID-19 occurred in South America in early 2021 and was mainly driven by Gamma and Lambda variants. In this study, we aimed to describe the emergence and local genomic diversity of the SARS-CoV-2 Lambda variant in Argentina, from its initial entry into the country until its detection ceased. Molecular surveillance was conducted on 9356 samples from Argentina between October 2020 and April 2022, and sequencing, phylogenetic, and phylogeographic analyses were performed. Our findings revealed that the Lambda variant was first detected in Argentina in January 2021 and steadily increased in frequency until it peaked in April 2021, with continued detection throughout the year. Phylodynamic analyses showed that at least 18 introductions of the Lambda variant into the country occurred, with nine of them having evidence of onward local transmission. The spatial--temporal reconstruction showed that Argentine clades were associated with Lambda sequences from Latin America and suggested an initial diversification in the Metropolitan Area of Buenos Aires before spreading to other regions in Argentina. Genetic analyses of genome sequences allowed us to describe the mutational patterns of the Argentine Lambda sequences and detect the emergence of rare mutations in an immunocompromised patient. Our study highlights the importance of genomic surveillance in identifying the introduction and geographical distribution of the SARS-CoV-2 Lambda variant, as well as in monitoring the emergence of mutations that could be involved in the evolutionary leaps that characterize variants of concern.

Cost-Effective Method to Perform SARS-CoV-2 Variant Surveillance: Detection of Alpha, Gamma, Lambda, Delta, Epsilon, and Zeta in Argentina.

SARS-CoV-2 variants with concerning characteristics have emerged since the end of 2020. Surveillance of SARS-CoV-2 variants was performed on a total of 4,851 samples from the capital city and 10 provinces of Argentina, during 51 epidemiological weeks (EWs) that covered the end of the first wave and the ongoing second wave of the COVID-19 pandemic in the country (EW 44/2020 to EW 41/2021). The surveillance strategy was mainly based on Sanger sequencing of a Spike coding region that allows the identification of signature mutations associated with variants. In addition, whole-genome sequences were obtained from 637 samples. The main variants found were Gamma and Lambda, and to a lesser extent, Alpha, Zeta, and Epsilon, and more recently, Delta. Whereas, Gamma dominated in different regions of the country, both Gamma and Lambda prevailed in the most populated area, the metropolitan region of Buenos Aires. The lineages that circulated on the first wave were replaced by emergent variants in a term of a few weeks. At the end of the ongoing second wave, Delta began to be detected, replacing Gamma and Lambda. This scenario is consistent with the Latin American variant landscape, so far characterized by a concurrent increase in Delta circulation and a stabilization in the number of cases. The cost-effective surveillance protocol presented here allowed for a rapid response in a resource-limited setting, added information on the expansion of Lambda in South America, and contributed to the implementation of public health measures to control the disease spread in Argentina.

Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review.

AIM: This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. BACKGROUND: An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. DATA SOURCES: A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. REVIEW METHODS: Twenty-two papers were included. The critical appraisal skills programme and prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. FINDINGS: People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. CONCLUSION: Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face.

La experiencia diaria del paciente cardiológico con un desfibrilador automático / The daily experience of the patient with an implantable cardioverter defibrillator

Objetivo Conocer la experiencia diaria de los pacientes con un desfibrilador automático implantado y los cambios adaptativos que se producen en estos pacientes.MétodoEstudio cualitativo y fenomenológico. Recogida de datos a través de entrevistas no estructuradas a la mitad de los informantes y, posteriormente, entrevistas semiestructuradas a través de una guía de preguntas abiertas construida tras las primeras entrevistas no estructuradas y la utilización de documentos escritos y narraciones personales de los informantes. Análisis de los datos a través de la propuesta de Van Manen.ResultadosSe analizaron las entrevistas de 10 participantes. Se recogieron variables sociodemográficas y se identificaron los siguientes temas que responden a la pregunta ¿cómo es vivir con un desfibrilador automático?: es vivir «con las dos caras de la moneda», vivir en una constante espera e incertidumbre, aceptar el cambio, desarrollar estrategias de adaptación, renegociar la relación de pareja y la sexualidad, y vivir transformado.ConclusionesLos resultados de este estudio pueden integrarse en la práctica clínica de las enfermeras en aspectos como la valoración tras el alta de cambios en hábitos, control del tratamiento, notificación de descargas, detección de ocultación de síntomas y de estrategias que puedan poner en riesgo al portador. Es preciso desarrollar líneas de investigación que profundicen en la influencia de otros dispositivos tecnológicos en las personas(AU)

Objective To describe the daily experience of patients with an automatic defibrillator (AD) implant and the adaptive changes of the patient.MethodQualitative and phenomenological research. Collection of data through; initially unstructured interview with half of the informants, semi-structured interviews through an open questions guide after the initial unstructured interviews and use of personal narratives of the informants. Analysis of the data using the Van Manen proposal.ResultsWe analysed the interviews of 10 participants. We collected socio-demographic variables and identified the following themes, which respond to the question “How is life with an AD”: It is life “with the two sides of the coin,” living in constant wait and uncertainty, accepting change, developing adaptation strategies, renegotiating relationships and sexuality and it is to live transformed.ConclusionsThe results of this study can be integrated into nurse clinical practice in areas such as valuation after discharge, changes in habits, control of treatment, notification of shocks, masking detection of symptoms and strategies that can jeopardise the bearer. Research needs to be developed that looks closer into the influence of other technological devices in people(AU)

[The daily experience of the patient with an implantable cardioverter defibrillator]. / La experiencia diaria del paciente cardiológico con un desfibrilador automático.

OBJECTIVE: To describe the daily experience of patients with an automatic defibrillator (AD) implant and the adaptive changes of the patient. METHOD: Qualitative and phenomenological research. Collection of data through; initially unstructured interview with half of the informants, semi-structured interviews through an open questions guide after the initial unstructured interviews and use of personal narratives of the informants. Analysis of the data using the Van Manen proposal. RESULTS: We analysed the interviews of 10 participants. We collected socio-demographic variables and identified the following themes, which respond to the question "How is life with an AD": It is life "with the two sides of the coin," living in constant wait and uncertainty, accepting change, developing adaptation strategies, renegotiating relationships and sexuality and it is to live transformed. CONCLUSIONS: The results of this study can be integrated into nurse clinical practice in areas such as valuation after discharge, changes in habits, control of treatment, notification of shocks, masking detection of symptoms and strategies that can jeopardise the bearer. Research needs to be developed that looks closer into the influence of other technological devices in people.

Early detection of functional and cognitive decline after hospital discharge: the role of community nursing and multidisciplinary teams.

This article features an individual example describing the multifactorial interventions of community nursing and a multidisciplinary team as they assess an older man's progressive functional decline, changes in behavior, and loss of previous social habits after being discharged from the hospital for the treatment of community-acquired pneumonia. Such nursing evaluation should include the following aspects: social environment, home environment, neighborhood characteristics, architectural barriers, capacity to perform activities of daily living, walking difficulties, risk of falling, changes in behavior and social habits, cognitive-affective state, pharmacological management, and the existence of nearby social organizations. The different approaches of community nursing and the multidisciplinary team are discussed.