Community-associated Clostridioides difficile infection in a general hospital from Argentina.

Toxin-producing Clostridioides difficile infection (CDI) is the leading cause of hospital-acquired diarrhea. However, it is now recognized as a cause of diarrhea in the community. This single-center study aimed to determine the epidemiological origin of CDI cases between January 2014 and December 2019 and to compare demographic characteristics, comorbidities, risk factors, severity, and mortality of community CDI with healthcare facility-associated CDI. There were 52 CDI cases from the community (34.4%). Community patients were significantly younger (53 yo vs. 65 yo), less comorbid (Charlson Index 1.65 vs. 3.98), and less severe (only one case). The main risk factor was the use of antibiotics in the previous 90 days (65%). However, we did not find any known risk factor in 7 patients.

Target-agnostic drug prediction integrated with medical record analysis uncovers differential associations of statins with increased survival in COVID-19 patients.

Importance: Drug repurposing requires distinguishing established drug class targets from novel molecule-specific mechanisms and rapidly derisking their therapeutic potential in a time-critical manner, particularly in a pandemic scenario. In response to the challenge to rapidly identify treatment options for COVID-19, several studies reported that statins, as a drug class, reduce mortality in these patients. However, it is unknown if different statins exhibit consistent function or may have varying therapeutic benefit. Objectives: To test if different statins differ in their ability to exert protective effects based on molecular computational predictions and electronic medical record analysis. Main Outcomes and Measures: A Bayesian network tool was used to predict drugs that shift the host transcriptomic response to SARS-CoV-2 infection towards a healthy state. Drugs were predicted using 14 RNA-sequencing datasets from 72 autopsy tissues and 465 COVID-19 patient samples or from cultured human cells and organoids infected with SARS-CoV-2, with a total of 2,436 drugs investigated. Top drug predictions included statins, which were then assessed using electronic medical records containing over 4,000 COVID-19 patients on statins to determine mortality risk in patients prescribed specific statins versus untreated matched controls. The same drugs were tested in Vero E6 cells infected with SARS-CoV-2 and human endothelial cells infected with a related OC43 coronavirus. Results: Simvastatin was among the most highly predicted compounds (14/14 datasets) and five other statins, including atorvastatin, were predicted to be active in > 50% of analyses. Analysis of the clinical database revealed that reduced mortality risk was only observed in COVID-19 patients prescribed a subset of statins, including simvastatin and atorvastatin. In vitro testing of SARS-CoV-2 infected cells revealed simvastatin to be a potent direct inhibitor whereas most other statins were less effective. Simvastatin also inhibited OC43 infection and reduced cytokine production in endothelial cells. Conclusions and Relevance: Different statins may differ in their ability to sustain the lives of COVID-19 patients despite having a shared drug target and lipid-modifying mechanism of action. These findings highlight the value of target-agnostic drug prediction coupled with patient databases to identify and clinically evaluate non-obvious mechanisms and derisk and accelerate drug repurposing opportunities.

[Physical Activity in Psychiatric inpatient Institutions In Ciudad de Buenos Aires]. / La actividad física durante la internación psiquiátrica en la Ciudad Autónoma de Buenos Aires.

There is growing evidence on the benefits of physical activity as a tool in treatment and prevention of psychiatric pathologies. The goal of this research is to obtain information on the implementation of physical activity as a therapeutic resource during the psychiatric hospitalization of adults in Ciudad de Buenos Aires. METHODOLOGY: A survey was designed to obtain information from each Inpatient adult institution in the aforementioned City on: whether or not physical activity was provided to patients during hospitalization, the reasons, the frequency, characteristics and duration of the activity as well as the benefits observed and / or known by the professionals who answered the survey. RESULTS: 71% of the institutions provide physical activity to their patients, nine are private and three are public. Adherence is higher in private institutions. The lack of resources and the fact that it is not considered important in psychiatric treatment are among the reasons why they consider that physical activity is not used as a therapeutic tool. CONCLUSIONS: Physical activity should be included in the therapeutic tools during psychiatric hospitalization, most of the institutions do include it.

Atuação ética e contextualizada nos estágios básicos supervisionados em Psicologia da Saúde: um relato de experiência de docentes / Ethical and contextualized performance in supervised basic internships in Health Psychology: an experience report by professor

A Psicologia, enquanto ciência e profissão, passou por algumas propostas curriculares e, com isso, discussões sobre ensino em psicologia têm se adensado, assim como os debates acerca das práticas na formação, com o reconhecimento da contribuição de estágios básicos ao longo do curso. O Sistema Único de Saúde auxiliou sobremaneira na demonstração do quanto a aproximação das diversas realidades em saúde ainda se faz necessária para uma atuação engajada da categoria. O objetivo deste trabalho é discutir a importância dos estágios para a formação da futura psicóloga. Utilizamos o relato de experiência de professoras do Internato em psicologia, uma modalidade específica em estágio básico, para problematizar a relevância do desenvolvimento de competências profissionais, que auxiliem na qualificação dessa atuação. Esse Internato está presente no quarto ano do curso de Psicologia de uma faculdade em Salvador, Bahia, e propõe a passagem de pequenos grupos de estudantes por campos variados da saúde e das organizações de trabalho. Compreendemos que o transitar do estudante por diversos contextos de prática na saúde e ter a mediação de uma professora são diferenciais para a formação na área. Essa proposta de estágio contribui para o desenvolvimento de um profissional crítico, ético, reflexivo e mais atento aos fenômenos que ocorrem com aqueles a quem presta serviço e a si mesmo. Estudos como este e outros com metodologias diversas podem auxiliar na construção de práticas profissionais e pedagógicas em Psicologia mais reflexivas e comprometidas com a nossa realidade brasileira.

Psychology, as a science and profession, has gone by some curricular proposals and, as a result, discussions about teaching in psychology have become more intense, as well as debates about practices in training with the recognition of the contribution of basic internships throughout the course. The Unified Brazilian Health System (SUS) helped a lot in demonstrating how much the approximation of the different realities in health is still necessary for an engaged performance of the category. The objective of this work is to discuss the importance of internships for the future psychologist's formation. We used the teachers of the internship in psychology's experience, a specific modality in basic internship, to problematize the relevance of the development of professional skills which help in the qualification of this performance. This internship is present in the fourth year of the Psychology course at a college in Salvador, Bahia, and proposes the passage of small groups of students through different fields of health and work organizations. We understood that the transit of the student through different contexts of practice in health and having the mediation of a teacher are differentials for training in the area. This internship proposal contributes to the development of a professional more critical, ethical, reflective and attentive to the phenomena that occur with those to himself and those whom he provides service. Studies like this and others with different methodologies can help in the construction of professional and pedagogical practices in Psychology that are more reflective and committed to our Brazilian reality.

Advances in the Synthesis of Fluorinated Scaffolds by Transition Metal-Catalyzed C-H Bond Activation.

Thanks to the unique features of the fluorine atom and the fluorinated groups, fluorine-containing molecules are essential. Therefore, the search for new fluorinated groups as well as straightforward and original methodologies for their installation is of prime importance. Especially, the combination of organofluorine chemistry with transition metal-catalyzed C-H bond functionalization reactions offered straightforward tools to access original fluorinated scaffolds. In this context, over the last years, our group focused on the development of original methodologies to synthesize fluorine-containing molecules with a special attention to emergent fluorinated groups. The present account highlights our recent contributions to the synthesis of highly value-added fluorine-containing compounds by transition metal-catalyzed C-H bond activation.

Late-stage C-H amination of abietane diterpenoids.

This study aims at highlighting the synthetic versatility of the rhodium-catalyzed C-H amination reactions using iodine(iii) oxidants for the late-stage functionalization of natural products. Inter- and intramolecular nitrene insertions have been performed from various abietane diterpenoids, leading to the amination of the C-3, C-6, C-7, C-11 and C-15 positions. Ca. 20 aminated compounds have been isolated with yields of up to 86% and high levels of regio-, chemo- and stereoselectivities.

Parálisis ácida aguda "polio-like" (Brote de 10 casos presentados en Buenos Aires - Argentina en 2016) / Acute acid paralysis "polio-like" (Outbreak of 10 cases presented in Buenos Aires - Argentina in 2016)

Resumen Objetivo Reportar un brote de 10 casos de mielopatías ácida aguda asimétrica por compromiso de la motoneurona espinal. Material y métodos: Relación V/M: 6/4 media de edad de 3 años, todos con parálisis ácida aguda, analizamos sus aspectos clínicos, etiológicos, neurorradiológicos, terapéuticos y evolutivos. Resultados: 8 presentaron parálisis áccida de miembros superiores asimétrica, 1 monoplejía de miembro inferior izquierdo, 1 hemiparesia, 5 sumaron compromiso de pares craneanos y 4 requirieron asistencia respiratoria mecánica. Todos coincidieron con catarro de vía aérea superior y/o ebre. La resonancia magnética medular fue anormal en todos, identi cando dos patrones de imágenes: uno lineal relacionado al compromiso del asta anterior y otro más heterogéneo con médula espinal engrosada, sin refuerzo con contraste, 5/10 presentaron además compromiso bulbo-protuberancial. Ninguno presento lesiones supratentoriales. En 4/10 identi camos enterovirus humano subtipo D68 HEV-D68) en secreciones de vía aérea y en 1/10 de ellos también en LCR. En el resto se detectaron otros enterovirus A, B y C, en uno rinovirus y otro In uenza. Nueve pacientes recibieron como tratamiento gammaglobulina y corticoides y 4 además recambio plasmático terapéutico sin mejoría clínica. Conclusiones: Ante una parálisis ácida aguda es importante descartar el HEV-D68. Consideramos los casos no detectados como "falsos negativos" dado que las muestras fueron tomadas tardíamente. Los otros virus identi cados no se han relacionado a mielopatías. Si bien la siopatología no es clara la ausencia de respuesta a tratamiento antin amatorio e inmunomodulador orienta a un mecanismo de agresión directa del virus. Se trata del primer reporte por HEV-D68 en Latinoamérica.

Abstract Objective: To report an outbreak of 10 cases of acute asymmetric accid myelopathy due to spinal motor neuron injury. Material and methods: Ten children, six male, with a mean age of 3 years presented with acute accid myelitis. We analyzed clinical features, etiology, neuroradiological images, treatment, and outcome. Results: Eight children had bilateral and asymmetric accid myelitis of the upper limbs, 1 had upper limb monoplegia, and 1 presented with hemiparesis. The cranial nerves were involved in 5 patients and 4 required mechanical ventilation. In all cases acute accid myelitis co-occurred with upper airway infection and/or fever. Spinal cord magnetic resonance imaging was abnormal in all, showing 2 di erent patterns: A linear pattern involving the anterior horns and another that was more heterogeneous showing spinal cord expansion. The lesions were non-enhancing in all. In 5/10 patients involvement of the medulla oblongata and pons was also observed. None of the patients presented with supratentorial lesions. In 4/10 children, the human enterovirus subtype D68 (HEV-D68) was identi ed in the airway and in 1/10 in the cerebrospinal uid as well. In the remaining patients di erent enterovirus species A, B, and C variants were detected, as well as rhinovirus in 1 and in uenza in another. Nine children received treatment with intravenous immunoglobulin and steroids and 4 of these children also underwent plasma exchange. Treatment did not lead to clinical improvement. Conclusions: In a patient with acute accid myelitis, HEV-D68 infection should be ruled out. Cases in which the virus was not detected were considered as "false negatives" as samples were collected late in course of the disease. The lack of response to anti-in ammatory and immunomodulatory treatment suggests a direct viral mechanism. This study is to our knowledge the rst on an HEV-D68-infection-related report in Latin America.

Enterovirus D68 infection in a cluster of children with acute flaccid myelitis, Buenos Aires, Argentina, 2016.

OBJECTIVE: To report a outbreak of 11 cases of acute asymmetric flaccid myelopathy due to spinal motor neuron injury. MATERIAL AND METHODS: Eleven children, six male, with a mean age of 3 years presented with acute flaccid myelitis. We analyzed clinical features, etiology, neuroradiological images, treatment, and outcome. RESULTS: Nine children had bilateral and asymmetric flaccid myelitis of the upper limbs, 1 had upper limb monoplegia, and 1 presented with hemiparesis. The cranial nerves were involved in 6 patients and 4 required mechanical ventilation. In all cases acute flaccid myelitis co-occurred with upper airway infection and/or fever. Spinal cord magnetic resonance imaging was abnormal in all, showing 2 different patterns: A linear pattern involving the anterior horns and another that was more heterogeneous showing spinal cord expansion. The lesions were non-enhancing in all. In 5/11 patients involvement of the medulla oblongata and pons was also observed. None of the patients presented with supratentorial lesions. In 4/11 children, the human enterovirus subtype D68 (HEV-D68) was identified in the airway and in 1/11 in the cerebrospinal fluid as well. In the remaining patients different enterovirus species A, B, and C variants were detected, as well as rhinovirus in 1 and influenza in another. Ten children received treatment with intravenous immunoglobulin and steroids and 4 of these children also underwent plasma exchange. Treatment did not lead to clinical improvement. CONCLUSIONS: In a patient with acute flaccid myelitis, HEV-D68 infection should be ruled out. Cases in which the virus was not detected were considered as "false negatives" as samples were collected late in course of the disease. The lack of response to anti-inflammatory and immunomodulatory treatment suggests a direct viral mechanism. This study is to our knowledge the first on an HEV-D68-infection-related cluster in Latin America.

Synthesis and cytotoxic activity evaluation of dihydrocucurbitacin B and cucurbitacin B derivatives.

Two cucurbitacins, dihydrocucurbitacin B (1) and cucurbitacin B (2), which can be obtained in large amounts from the roots of Wilbrandia ebracteata and from the fruits of Luffa operculata, respectively, were used as starting materials for the preparation of a library of 29 semi-synthetic derivatives. The structural changes that were performed include the removal, modification or permutation of functional groups in rings A and B as well as in the side chain. All new semisynthetic compounds, as well as 1 and 2, were tested in vitro for their cytotoxic effects on non-small-cell lung cancer cells (A549 cells). Some of these compound displayed potent to moderate activity against A549 tumor cells, especially those cucurbitacin B derivatives which were modified at ring A.