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1.
Trials ; 22(1): 111, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33522946

RESUMEN

OBJECTIVES: To evaluate whether a single high dose of oral cholecalciferol improves the respiratory outcomes as compared with placebo among adults COVID-19 patients at moderate risk of clinical complications. TRIAL DESIGN: The CARED trial is an investigator-initiated, multicentre, randomized, parallel, two-arm, sequential, double-blind and placebo-controlled clinical trial. It was planned as a pragmatic trial since the inclusion criteria are broad and the study procedures are as simple as possible, in order to be implemented in the routine clinical practice in general wards in the pandemic setting and a middle-income country context. The sequential design involves two stages. The first stage will assess the effects of vitamin D supplementation on blood oxygenation (physiological effects). The second stage will assess the effects on clinical outcomes. PARTICIPANTS: Participants of either gender admitted to general adult wards in 21 hospital sites located in four provinces of Argentina are invited to participate in the study if they meet the following inclusion criteria and none of the exclusion criteria: Inclusion criteria SARS-CoV-2 confirmed infection by RT-PCR; Hospital admission at least 24 hours before; Expected hospitalization in the same site ≥24 hours; Oxygen saturation ≥90% (measured by pulse oximetry) breathing ambient air; Age ≥45 years or at least one of the following conditions: ○ Hypertension; ○ Diabetes; ○ At least moderate COPD or asthma; ○ Cardiovascular disease (history of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting or valve replacement surgery); ○ Body mass index ≥30; Willingness to sign informed consent (online supplementary material 1 and 2). EXCLUSION CRITERIA: Age <18 years; Women in childbearing age; >= 72 hs since current admission; Requirement for a high dose of oxygen (>5 litres/minute) or mechanical ventilation (non-invasive or invasive); History of chronic kidney disease requiring haemodialysis or chronic liver failure; Inability for oral intake. Chronic supplementation with pharmacological vitamin D; Current treatment with anticonvulsants; History of: ○ Sarcoidosis; ○ Malabsorption syndrome; ○ Known hypercalcemia or serum calcium >10.5 mg/dL; Life expectancy <6 months; Known allergy to study medication; Any condition at discretion of investigator impeding to understand the study and give informed consent. INTERVENTION AND COMPARATOR: The intervention consists in a single oral dose of 500.000 IU of commercially available cholecalciferol soft gel capsules (5 capsules of 100.000 IU) or matching placebo MAIN OUTCOMES: The primary outcome for the first stage is the change in the respiratory Sepsis-related Organ Failure Assessment (SOFAr) score between pre-treatment value and the worst value recorded during the first 7 seven days of hospitalization, the death or discharge, whichever occurs first. The SOFAr score measured as the ratio between the pulse oximetry saturation (SpO2) and FiO2 (27, 28) is used instead of the arterial partial pressure of oxygen (PaO2). SOFAr score is a 4-points scale, with higher values indicating deeper respiratory derangement as follows: 1 PaO2 <400; 2 PaO2 <300; 3 PaO2 <200; 4 PaO2 <100. The primary outcome for the second stage is the combined occurrence of requirement ≥40% of FiO2, invasive or non-invasive ventilation, up to 30 days or hospital discharge. RANDOMISATION: A computer-generated random sequence and the treatment assignment is performed through the web-based randomization module available in the electronic data capture system (Castor®). A randomization ratio 1:1, stratified and with permuted blocks was used. Stratification variables were diabetes (yes/no), age (≤60/>60 years) and the site. BLINDING (MASKING): Double-blind was achieved by using placebo soft gel capsules with the same organoleptic properties as the active medication. Central management of the medication is carried out by a pharmacist in charge of packaging the study drug in unblinded fashion, who have no contact with on-site investigators. Medication is packaged in opaque white bottles, each containing five soft gel capsules of the active drug or matching placebo, corresponding to complete individual treatment. Treatment codes are kept under the pharmacist responsibility, and all researchers are unaware of them. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The first stage is planned to include 200 patients (100 per group), the second stage is planned to include 1064 additional patients. The total sample size is 1264 patients. TRIAL STATUS: Currently the protocol version is the number 1.4 (from October 13th, 2020). The recruitment is ongoing since August 11th, 2020, and the first subject was enrolled on August 14th. Since then, 21 sites located in four provinces of Argentina were initiated, and 167 patients were recruited by January 11th, 2021. We anticipate to finish the recruitment for the first stage in mid-February, 2021, and in August, 2021 for the second stage. TRIAL REGISTRATION: The study protocol is registered in ClinicalTrials.gov (identifier number NCT04411446 ) on June 2, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Asunto(s)
/dietoterapia , Colecalciferol/administración & dosificación , Pandemias , Vitaminas/administración & dosificación , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , /virología , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Admisión del Paciente , Ensayos Clínicos Pragmáticos como Asunto , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Resultado del Tratamiento
2.
PLoS One ; 16(2): e0246793, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571300

RESUMEN

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.


Asunto(s)
/epidemiología , /fisiopatología , Adulto , Argentina/epidemiología , Asma/epidemiología , Asma/fisiopatología , Comorbilidad , Tos/epidemiología , Tos/fisiopatología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Femenino , Fiebre/epidemiología , Fiebre/fisiopatología , Cefalea/epidemiología , Cefalea/fisiopatología , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
3.
Medicina (B Aires) ; 81(1): 1-5, 2021.
Artículo en Español | MEDLINE | ID: mdl-33611237

RESUMEN

Hepatitis C virus (HCV) infection is currently the main blood-borne viral infection. One of the main obstacles to achieving its control in Argentina is related to difficulties in accessing the diagnosis and timely treatment of infected people. We carried out this study with the aim of characterizing the HCV-infected patients who started treatment with direct-acting antivirals (DAAs) and to describe the experience related to treatment. The medical records of 82 patients, 44 (53.7%) male, 37 (45.1%) female, and one (1.2%) transgender, were selected. The mean age was 49 years. We report a frequency of cirrhosis, 39%, in 32 patients, coinfection with HIV in 48 (58.5%) and with HBV in 27 (32.9%). In 52 patients (63.4%), no risk factor clearly associated with infection was observed. All completed the therapy, of them 72 (87.8%) carried out the control to confirm sustained viral response (SVR), that attained 98.6%. We conclude that universal testing should be implemented over testing based on a risk approach, and that a simplified and decentralized care criterion should be promoted, reserving specialized care for patients with decompensated cirrhosis and liver cancer.


Asunto(s)
Antivirales , Coinfección , Infecciones por VIH , Hepatitis C Crónica , Hepatitis C , Antivirales/uso terapéutico , Argentina/epidemiología , Coinfección/tratamiento farmacológico , Femenino , Infecciones por VIH/tratamiento farmacológico , Hepacivirus , Hepatitis C/diagnóstico , Hepatitis C/tratamiento farmacológico , Hepatitis C/epidemiología , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Cirrosis Hepática , Masculino , Persona de Mediana Edad
4.
Neurología (Barc., Ed. impr.) ; 36(1): 9-15, ene.-feb. 2021. tab, graf
Artículo en Español | IBECS | ID: ibc-192836

RESUMEN

INTRODUCCIÓN: Varios países del mundo padecen una grave carga en sus sistemas de salud como consecuencia de la pandemia por COVID-19. Esta realidad pone en riesgo el seguimiento de patologías crónicas como las demencias. Asimismo, la atención de las posibles complicaciones neuropsiquiátricas relacionadas con el aislamiento preventivo de la población (cuarentena), que en el caso de Argentina se considera la más prolongada de Latinoamérica. El objetivo del presente trabajo es determinar la frecuencia de las distintas modalidades de consulta médica en relación con la patología neurocognitiva del paciente y las variables predictoras de consulta desde el inicio de la cuarentena. MÉTODOS: Estudio descriptivo observacional y transversal basado en la recolección de datos a través de una encuesta. RESULTADOS: Hubo 324 participantes, 165 (50,9%) de los cuales realizaron al menos una consulta médica. Frecuencia de modalidades de consulta: teléfono, 109 (33,6%); correo electrónico, 62 (19,1%); videoconsulta, 30 (9,3%); servicio de emergencias, 23 (7,1%). Predictores de consulta: Clinical Dementia Rating ≥ 1 (p < 0,001); diagnóstico: Alzheimer (p = 0,017). Se encontraron puntajes más altos del Inventario Neuropsiquiátrico (NPI) en el grupo que ha realizado consultas médicas (p < 0,001). Dicha diferencia no fue observada en el puntaje de la escala de carga del cuidador (Zarit). CONCLUSIÓN: Evidenciamos alta prevalencia de trastornos conductuales en pacientes y de sobrecarga en cuidadores durante la cuarentena. Solamente el 50% accedió a una consulta médica (52,7% por modalidad telefónica y correo electrónico). Es necesario extremar los cuidados en personas con demencia, garantizando el seguimiento de su patología


INTRODUCTION: Health systems in numerous countries around the world are suffering a serious burden as a consequence of the COVID-19 pandemic. As a result of this situation, the follow-up of such chronic diseases as dementia may be at risk. Similarly, neuropsychiatric complications related to lockdown measures may also be neglected; Argentina's lockdown has been the longest implemented in Latin America. This study aims to determine the frequency of the different types of medical consultations for neurocognitive disorders and the predictors for requiring consultation since the beginning of the lockdown. METHODS: We performed a descriptive, observational, cross-sectional study based on data collected through an online survey. RESULTS: Data were collected on 324 participants, with 165 (50.9%) having had at least one medical consultation. Consultations were held by telephone in 109 cases (33.6%), by e-mail in 62 (19.1%), by video conference in 30 (9.3%), and at the emergency department in 23 (7.1%). Predictors of requiring consultation were Clinical Dementia Rating scores ≥1 (P < .001) and diagnosis of Alzheimer disease (P = .017). Higher Neuropsychiatric Inventory scores were found in the group of respondents who did require medical consultation (P < .001), but no significant differences were found between groups for Zarit Burden Interview scores. CONCLUSION: We identified a high prevalence of behavioural disorders and caregiver burden during lockdown. Nevertheless, only 50% of respondents had sought medical consultation (by telephone or email in 52.7% of cases). Care of people with dementia must be emphasised, guaranteeing follow-up of these patients


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Derivación y Consulta/estadística & datos numéricos , Trastornos Neurocognitivos , Cuidadores , Enfermedad de Alzheimer , Demencia , Encuestas y Cuestionarios , Estudios de Seguimiento , Estudios Transversales , Argentina/epidemiología
5.
Parasit Vectors ; 14(1): 35, 2021 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-33422133

RESUMEN

BACKGROUND: Peri-urban and urban settings have recently gained more prominence in studies on vector-borne transmission of Trypanosoma cruzi due to sustained rural-to-urban migrations and reports of urban infestations with triatomines. Prompted by the finding of Triatoma infestans across the rural-to-urban gradient in Avia Terai, an endemic municipality of the Argentine Chaco, we assessed selected components of domestic transmission risk in order to determine its variation across the gradient. METHODS: A baseline vector survey was conducted between October 2015 and March 2016, following which we used multistage random sampling to select a representative sample of T. infestans at the municipal level. We assessed T. cruzi infection and blood-feeding sources of 561 insects collected from 109 houses using kinetoplast DNA-PCR assays and direct enzyme-linked immunosorbent assays, respectively. We stratified triatomines according to their collection site (domestic or peridomestic), and we further categorized peridomestic sites in ecotopes of low- or high-risk for T. cruzi infection. RESULTS: The overall adjusted prevalence of T. cruzi-infected T. infestans was 1.8% (95% confidence interval [CI] 1.3-2.3) and did not differ between peri-urban (1.7%) and rural (2.2%) environments. No infection was detected in bugs captured in the urban setting; rather, infected triatomines were mainly collected in rural and peri-urban domiciles, occurring in 8% of T. infestans-infested houses. The main blood-feeding sources of domestic and peridomestic triatomines across the gradient were humans and chickens, respectively. The proportion of triatomines that had fed on humans did not differ between peri-urban (62.5%) and rural (65.7%) domiciles, peaking in the few domestic triatomines collected in urban houses and decreasing significantly with an increasing proportion of chicken- and dog- or cat-fed bugs. The relative odds ratio (OR) of having a T. cruzi infection was nearly threefold higher in bugs having a blood meal on humans (OR 3.15), dogs (OR 2.80) or cats (OR: 4.02) in a Firth-penalized multiple logistic model. CONCLUSIONS: Trypanosoma cruzi transmission was likely occurring both in peri-urban and rural houses of Avia Terai. Widespread infestation in a third of urban blocks combined with high levels of human-triatomine contact in the few infested domiciles implies a threat to urban inhabitants. Vector control strategies and surveillance originally conceived for rural areas should be tailored to peri-urban and urban settings in order to achieve sustainable interruption of domestic transmission in the Chaco region.


Asunto(s)
Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/transmisión , Insectos Vectores/parasitología , Triatoma , Trypanosoma cruzi , Adulto , Animales , Argentina/epidemiología , Gatos , Pollos , Perros , Ensayo de Inmunoadsorción Enzimática , Conducta Alimentaria , Femenino , Cabras , Humanos , Masculino , Ratones , Factores de Riesgo , Población Rural
6.
BMJ Open ; 11(1): e044592, 2021 01 20.
Artículo en Inglés | MEDLINE | ID: mdl-33472790

RESUMEN

OBJECTIVE: To summarise the unfolding of the COVID-19 epidemic among slum dwellers and different social strata in the city of Buenos Aires during the first 20 weeks after the first reported case. DESIGN: Observational study using a time-series analysis. Natural experiment in a big city. SETTING: Population of the city of Buenos Aires and the integrated health reporting system records of positive RT-PCR for COVID-19 tests. PARTICIPANTS: Records from the Argentine Integrated Health Reporting System for all persons with suspected and RT-PCR-confirmed diagnosis of COVID-19 between 31 January and 14 July 2020. OUTCOMES: To estimate the effects of living in a slum on the standardised incidence rate of COVID-19, corrected Poisson regression models were used. Additionally, the impact of socioeconomic status was performed using an ecological analysis at the community level. RESULTS: A total of 114 052 people were tested for symptoms related with COVID-19. Of these, 39 039 (34.2%) were RT-PCR positive. The incidence rates for COVID-19 towards the end of the 20th week were 160 (155 to 165) per 100 000 people among the inhabitants who did not reside in the slums (n=2 841 997) and 708 (674 to 642) among slums dwellers (n=233 749). Compared with the better-off socioeconomic quintile (1.00), there was a linear gradient on incidence rates: 1.36 (1.25 to 1.46), 1.61 (1.49 to 1.74), 1.86 (1.72 to 2.01), 2.94 (2.74 to 3.16) from Q2 to Q5, respectively. Slum dwellers were associated with an incidence rate of 14.3 (13.4 to 15.4). CONCLUSIONS: The distribution of the epidemic is socially conditioned. Slum dwellers are at a much higher risk than the rest of the community. Slum dwellers should not be considered just another risk category but an entirely different reality that requires policies tailored to their needs.


Asunto(s)
/estadística & datos numéricos , Disparidades en el Estado de Salud , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Niño , Preescolar , Femenino , Política de Salud , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Adulto Joven
7.
Parasitol Res ; 120(2): 443-450, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33409635

RESUMEN

Pediculosis is a worldwide disease affecting school-aged children produced by the presence of the head louse, Pediculus humanus capitis De Geer, an obligate ectoparasite on the human scalp feeding exclusively on blood. Transmission occurs primarily through direct physical head-to-head contact. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic. COVID-19 is caused by SARS-CoV-2, a variant of the coronavirus. Therefore, on March 18, 2020, the Argentinean government established mandatory isolation for an indefinite period. This obligatory isolation interrupted regular classes avoiding direct contact between children, thus affecting the dispersal route of individuals and the evolution of head louse populations. In this study, we evaluated through an online survey how confinement affected the prevalence of lice during lockdown compared to the situation prior to confinement. The survey allowed to discriminate the different control strategies, the number of treatments, and the amount of insects recorded by parents. Data of 1118 children obtained from 627 surveys were analyzed. As the main result, it was observed that prevalence of lice decreased significantly from before (69.6%) to during (43.9%) COVID-19 lockdown. Moreover, head lice infestation was more effectively controlled in households with up to 2 children in comparison to households with 3 or more children. This is the first study that analyzed the prevalence of head lice during COVID-19 pandemic. In addition, this work demonstrated the impact of social distance in the population dynamics of head lice and how it could affect the control strategies in the future.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles/métodos , Infestaciones por Piojos/epidemiología , Pediculus/fisiología , Animales , Argentina/epidemiología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Infestaciones por Piojos/parasitología , Infestaciones por Piojos/prevención & control , Masculino , Pandemias , Prevalencia , Encuestas y Cuestionarios
8.
BMC Infect Dis ; 21(1): 73, 2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33446117

RESUMEN

BACKGROUND: In pregnant women Streptococcus agalactiae (GBS) can be transmitted to newborn causing severe infections. It is classified into 10 serotypes (Ia, Ib, II-IX). The severity of neonatal disease is determined by the capsular serotype and virulence factors such as the polysaccharide capsule, encoded by the cps gene, protein C, which includes the Cα surface proteins (bca gene), Rib (rib gene) and Cß (bac gene); the proteins Lmb (lmb gene), FbsB (fbsB gene), FbsA (fbsA gene), the cyl operon encoding a ß-hemolysin (hylB gene), the CAMP factor (cfb gene) and the C5a peptidase (scpB gene). The aim of this work was to determine the degree of GBS colonization in pregnant women, the serotypes distribution and to investigate virulence-associated genes. METHODS: We worked with 3480 samples of vagino-rectal swabs of women with 35-37 weeks of gestation. The identification of the strains was carried out using conventional biochemical tests and group confirmatory serology using a commercial latex particle agglutination kit. Two hundred GBS strains were selected. Their serotype was determined by agglutination tests. The monoplex PCR technique was used to investigate nine virulence-associated genes (cps, bca, rib, bac, lmb, fbsB, fbsA, hylB and scpB). RESULTS: The maternal colonization was 9.09%. The serotypes found were: Ia (33.50%), III (19.00%), Ib (15.50%), II (14.00%), V (7.00%) and IX (5.50%). 5.50% of strains were found to be non-serotypeable (NT). The nine virulence genes investigated were detected simultaneously in 36.50% of the strains. The genes that were most frequently detected were scpB (100.00%), fbsA (100.00%), fbsB (100.00%), cylB (95.00%), lmb (94.00%) and bca (87.50%). We found associations between serotype and genes bac (p = 0.003), cylB (p = 0.02), rib (p = 0.01) and lmb (p < 0.001). CONCLUSIONS: The frequency of vaginal-rectal colonization, serotypes distribution and associated virulence genes, varies widely among geographical areas. Therefore, epidemiological surveillance is necessary to provide data to guide decision-making and planning of prevention and control strategies.


Asunto(s)
Genes Bacterianos , Edad Gestacional , Serogrupo , Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae/aislamiento & purificación , Streptococcus agalactiae/patogenicidad , Factores de Virulencia/genética , Adulto , Argentina/epidemiología , Proteínas Bacterianas/genética , Femenino , Humanos , Reacción en Cadena de la Polimerasa , Embarazo , Prevalencia , Infecciones Estreptocócicas/microbiología , Virulencia/genética
9.
PLoS Pathog ; 17(1): e1009161, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33444413

RESUMEN

We report the emergency development and application of a robust serologic test to evaluate acute and convalescent antibody responses to SARS-CoV-2 in Argentina. The assays, COVIDAR IgG and IgM, which were produced and provided for free to health authorities, private and public health institutions and nursing homes, use a combination of a trimer stabilized spike protein and the receptor binding domain (RBD) in a single enzyme-linked immunosorbent assay (ELISA) plate. Over half million tests have already been distributed to detect and quantify antibodies for multiple purposes, including assessment of immune responses in hospitalized patients and large seroprevalence studies in neighborhoods, slums and health care workers, which resulted in a powerful tool for asymptomatic detection and policy making in the country. Analysis of antibody levels and longitudinal studies of symptomatic and asymptomatic SARS-CoV-2 infections in over one thousand patient samples provided insightful information about IgM and IgG seroconversion time and kinetics, and IgM waning profiles. At least 35% of patients showed seroconversion within 7 days, and 95% within 45 days of symptoms onset, with simultaneous or close sequential IgM and IgG detection. Longitudinal studies of asymptomatic cases showed a wide range of antibody responses with median levels below those observed in symptomatic patients. Regarding convalescent plasma applications, a protocol was standardized for the assessment of end point IgG antibody titers with COVIDAR with more than 500 plasma donors. The protocol showed a positive correlation with neutralizing antibody titers, and was used for clinical trials and therapies across the country. Using this protocol, about 80% of convalescent donor plasmas were potentially suitable for therapies. Here, we demonstrate the importance of providing a robust and specific serologic assay for generating new information about antibody kinetics in infected individuals and mitigation policies to cope with pandemic needs.


Asunto(s)
/virología , Glicoproteína de la Espiga del Coronavirus/inmunología , Adulto , Anciano , Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/inmunología , Formación de Anticuerpos , Argentina/epidemiología , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pandemias , Estudios Seroepidemiológicos
10.
Arch Virol ; 166(3): 881-884, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33433694

RESUMEN

In the present study, we serosurveyed the exposure of 222 draft horses to different arboviruses in the city of Santa Fe, Argentina. Plaque reduction neutralization tests confirmed exposure to Fort Sherman virus (FSV), Saint Louis encephalitis virus (SLEV), West Nile virus (WNV), and Río Negro virus (RNV). Apparently, Western and Eastern equine encephalitis viruses did not circulate in the population tested. The confirmation of five seroconversions for WNV, FSV, and SLEV and the association between prevalence and age are indicative of recent circulation. These results highlight the importance of considering draft horses in arboviral surveillance in urban and rural areas of developing countries.


Asunto(s)
Infecciones por Alphavirus/epidemiología , Anticuerpos Antivirales/sangre , Infecciones por Bunyaviridae/epidemiología , Encefalitis de San Luis/epidemiología , Enfermedades de los Caballos/epidemiología , Fiebre del Nilo Occidental/epidemiología , Alphavirus/inmunología , Alphavirus/aislamiento & purificación , Infecciones por Alphavirus/veterinaria , Animales , Argentina/epidemiología , Infecciones por Bunyaviridae/veterinaria , Virus de la Encefalitis de San Luis/inmunología , Virus de la Encefalitis de San Luis/aislamiento & purificación , Encefalitis de San Luis/veterinaria , Enfermedades de los Caballos/virología , Caballos , Orthobunyavirus/inmunología , Orthobunyavirus/aislamiento & purificación , Seroconversión , Fiebre del Nilo Occidental/veterinaria , Virus del Nilo Occidental/inmunología , Virus del Nilo Occidental/aislamiento & purificación
11.
J Affect Disord ; 282: 495-503, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33422827

RESUMEN

The unique circumstances created by the COVID-19 pandemic pose serious challenges to mood stability and emotional regulation at all ages. Although many people tend to react resiliently to stress, others appear to display emotional anxiety and depression-related symptoms. In this study, we carried out a survey (N = 10,053) during the first week of the general lockdown (quarantine) in Argentina to measure early affective reactions in Argentine adults. Respondents showed substantial anxious and depressive symptoms, with 33% and 23% of participants reporting possible depressive and anxious syndromes, respectively, with the youngest group (18 to 25 y.o.) showing the highest prevalence of symptoms. Even if prior mental health problems predisposed or aggravated the reaction, participants without prior complaints showed signs of psychological impact. Using linear regression, the most important independent variables related to depressive symptoms were the feeling of loneliness followed by daily stress. In the case of anxious states, the strongest variables were negative repetitive thinking and feeling of loneliness. Other psychological, economic, and social factors are discussed. This study is in line with previous literature that highlight the importance of the psychological impact of pandemics, but additionally demonstrates that these reactions are present at a large scale immediately after the start of quarantine with very low infectious rates as an early anticipatory adaptive reaction leading to potential negative outcomes from adjustment disorders to major disorders. In addition, the present results provide potentially relevant information about sudden environmental impacts on affective states and specific pathways for anxiety and depression to be expressed. We end by discussing implications for public policy based on considering the most vulnerable groups.


Asunto(s)
Pandemias , Adulto , Ansiedad/epidemiología , Argentina/epidemiología , Control de Enfermedades Transmisibles , Depresión , Humanos , Salud Mental , Cuarentena , Estrés Psicológico/epidemiología
12.
Emerg Infect Dis ; 27(2): 348-351, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33347804

RESUMEN

An epidemic of dengue virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infections occurred in Argentina during 2020. We describe the clinical characteristics and outcomes in a cohort of patients hospitalized because of co-infection. We retrospectively identified 13 patients from different hospitals in Buenos Aires who had confirmed infection with SARS-CoV-2 and dengue virus and obtained clinical and laboratory data from clinical records. All patients had febrile disease when hospitalized. Headache was a common symptom. A total of 8 patients had respiratory symptoms, 5 had pneumonia, and 3 had rash. Nearly all patients had lymphopenia when hospitalized. No patients were admitted to an intensive care unit or died during follow up. Co-infection with SARS-CoV-2 and dengue virus can occur in patients living in areas in which both viruses are epidemic. The outcome of these patients did not seem to be worse than those having either SARS-CoV-2 or dengue infection alone.


Asunto(s)
/epidemiología , Dengue/epidemiología , Adulto , Argentina/epidemiología , Coinfección , Dengue/complicaciones , Femenino , Humanos , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
13.
Artículo en Inglés | MEDLINE | ID: mdl-33374162

RESUMEN

In November 2019, the world was introduced to a new coronavirus that has since ravaged it. Argentina began to see an increase of COVID-19 quickly in the new year and as of April 2020 the country was still being burdened by the transmission of the virus. With the progression of the epidemic turning into a pandemic, health authorities constantly updated health prevention strategies and responses to the novel coronavirus in its first wave. The Center for Disease Control and Prevention (CDC) issued a level three warning for international travel to/from Argentina because of COVID-19's rapid transmission. With Argentina's already fragile economy, health systems had to meet the challenge of being able to treat the infected. This case presentation aims to provide an overview of Argentina's earliest epidemiological situation of the COVID-19 pandemic. The data provided in this study concern Argentina's COVID-19 situation during the period of January 2020-April 2020. Mathematical modeling was used to forecast COVID-19 transmission after the first wave, specifically focusing on Buenos Aires. The country's demographics and an impression of its health systems will be analyzed in this case presentation for preparedness. The case study concludes in depicting Argentina's current and anticipated economic, social, and political disruptions because of the first wave of the pandemic.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/métodos , Pandemias/prevención & control , Argentina/epidemiología , Humanos , Modelos Teóricos
14.
Viruses ; 13(1)2020 12 25.
Artículo en Inglés | MEDLINE | ID: mdl-33375530

RESUMEN

In rabies diagnosis, it is essential to count on a rapid test to give a quick response. The combined sensitivity and robustness of the TaqMan RT-PCR assays (qRT-PCR) have made these methods a valuable alternative for rabies virus (RABV) detection. We conducted a study to compare the applicability of two widely used qRT-PCR assays targeting the nucleoprotein gene (LysGT1 assay) and leader sequences (LN34 qRT-PCR assay) of RABV genomes, in all variants circulating in Argentina. A total of 44 samples obtained from bats, dogs, cattle, and horses, that were previously tested for rabies by FAT and conventional RT-PCR, were used in the study. All variants were successfully detected by the pan-lyssavirus LN34 qRT-PCR assay. The LysGT1 assay failed to detect three bat-related variants. We further sequenced the region targeted by LysGT1 and demonstrated that the presence of three or more mismatches with respect to the primers and probe sequences precludes viral detection. We conclude that the LysGT1 assay is prone to yield variant-dependent false-negative test results, and in consequence, the LN34 assay would ensure more effective detection of RABV in Argentina.


Asunto(s)
Variación Genética , Virus de la Rabia/genética , Rabia/diagnóstico , Rabia/virología , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Secuencia de Aminoácidos , Animales , Argentina/epidemiología , Bovinos , Quirópteros , Geografía Médica , Caballos , Humanos , Nucleoproteínas/genética , Filogenia , Filogeografía , ARN Viral , Rabia/epidemiología , Virus de la Rabia/clasificación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos
15.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(6): 375-379, nov.-dic. 2020. ilus, graf
Artículo en Español | IBECS | ID: ibc-194659

RESUMEN

En esta publicación se presentan criterios y fundamentos para la organización del trabajo en la práctica segura de la Radiofarmacia Hospitalaria, a fin de minimizar el riesgo de transmisión viral durante la pandemia de COVID-19, en una instalación de referencia de la Comisión Nacional de Energía Atómica de Argentina, mientras se continúan desempeñando servicios esenciales para el sistema de salud. Con este fin se consultaron como referencia documentos de la Comisión Nacional de Energía Atómica, OIEA, la OMS y otras publicaciones científicas. Estas recomendaciones se encuentran en proceso de revisión constante y son actualizadas de manera permanente. En este marco se propone el presente modelo de organización laboral para esta actividad esencial incluyendo recomendaciones generales, particulares y su fundamento epidemiológico e inmunológico


This publication presents criteria and bases for the work organization in the safe practice of Hospital Radiopharmacy, in order to minimize the risk of viral transmission during the COVID-19 pandemic, in a reference facility of the National Energy Commission Atomic of Argentina, while continuing to perform essential services for the health system. For this purpose, documents from the National Energy Commission Atomic, IAEA, WHO and other scientific publications were consulted as reference. These recommendations are under constant review and are permanently updated. Within this framework, the present model of work organization for this essential activity is proposed, including general and specific recommendations and its epidemiological and immunological basis


Asunto(s)
Humanos , Virus del SRAS/patogenicidad , Infecciones por Coronavirus/epidemiología , Radiofármacos/provisión & distribución , Servicios Farmacéuticos/organización & administración , Factores de Riesgo , Infecciones por Coronavirus/prevención & control , Pandemias/estadística & datos numéricos , Argentina/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Precauciones Universales/métodos , Buenas Prácticas de Dispensación
16.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 191-198, dic. 2020. tab
Artículo en Español | LILACS | ID: biblio-1145493

RESUMEN

Introducción: el siguiente estudio tuvo como finalidad explorar algunas características demográficas asociadas al dolor crónico y el desarrollo de ideas de suicidio en una población de pacientes mayores de 65 años. Método: se realizó un estudio observacional y analítico de corte transversal mediante el relevamiento de datos a partir historias clínicas de pacientes mayores de 65 años que concurrieron a los consultorios externos del equipo de geriatría del Servicio de Psiquiatría del Hospital Italiano de Buenos Aires, entre junio de 2018 y diciembre de 2018. Resultados: se incluyó en el estudio un total de 222 pacientes, de los cuales 50 (23%) presentaron indicadores de dolor crónico y 33 pacientes (14,6%) lo hicieron de ideación suicida. Mediante estudio de correlación se estableció que estar ocupado, padecer dolor crónico y haber tenido más de una internación psiquiátrica son factores que incrementan el riesgo de presentar ideación suicida. Las variables ideación suicida, edad, y el estado civil ‒separado o divorciado en comparación con estar casado‒ son factores asociados a la presencia de dolor crónico. Conclusiones: el dolor crónico y la ideación suicida son factores que contribuyen a aumentar la fragilidad en personas mayores y deben ser estudiados en mayor profundidad para comprender los distintos modos de expresión de la patología psiquiátrica en esta población. (AU)


Introduction: the following study aimed to explore some demographic characteristics associated with chronic pain and the development of suicidal ideas in a population of patients over 65 years. Method: an cross-sectional observational and analytical study was carried out by collecting data from clinical histories of patients over 65 years of age who attended the external offices of the geriatrics team of the Psychiatry service of the Italian Hospital of Buenos Aires between June 2018 and December 2018. Results: a total of 222 patients were included in the study, of which 50 (23%) presented indicators of chronic pain and 33 patients (14.6%) had suicidal ideation. A correlation study established that being employed, suffering from chronic pain and having had more than one psychiatric hospitalization are factors that increase the risk of presenting suicidal ideation. The variables suicidal ideation, age, and separated or divorced marital status compared to being married are factors associated with the presence of chronic pain. Conclusions: chronic pain and suicidal ideation are factors that contribute to increasing frailty in elderly patients and should be studied in greater depth to understand the different modes of expression of psychiatric pathology in this population. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Ideación Suicida , Dolor Crónico/epidemiología , Argentina/epidemiología , Psicotrópicos/uso terapéutico , Suicidio/psicología , Suicidio/estadística & datos numéricos , Pesar , Estudios Transversales , Factores de Riesgo , Factores de Edad , Estado Civil/estadística & datos numéricos , Demencia/psicología , Dolor Crónico/psicología , Disfunción Cognitiva/psicología , Fragilidad/psicología , Psiquiatría Geriátrica/estadística & datos numéricos
17.
Dis Aquat Organ ; 142: 33-40, 2020 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-33210609

RESUMEN

Pinniped tuberculosis, commonly caused by Mycobacterium pinnipedii, is a zoonotic disease reported in free-living and captive otariid species of the southern hemisphere. Currently, data concerning pinniped tuberculosis in South America are scarce, reinforcing the need for further studies of the disease in free-ranging pinnipeds. In this study, we investigated the presence of tuberculosis in South American sea lions Otaria flavescens (SASLs) stranded along the Chubut coastline (Argentina). Necropsies were performed in 9 SASLs, and tissue samples were collected for histopathology, bacteriology, and molecular diagnosis. Four SASLs showed enlarged tracheobronchial lymph nodes (TBLNs) with multifocal to coalescing granulomas. In these animals, a direct IS6110-PCR amplification confirmed the presence of a Mycobacterium tuberculosis complex member in TBLNs (n = 4) and lungs (n = 2), but the agent could not be further identified. In one SASL, Mycobacterium murale was isolated from lungs without lesions. This study confirms the presence of tuberculosis in SASLs from Chubut, where tourist activities promote close interaction with the animals, generating a potential risk to human health. Further research is currently focusing on addressing the prevalence of tuberculosis in wild SASLs, to assess the risk for public health and develop management strategies to avoid human infection.


Asunto(s)
Mycobacterium , Leones Marinos , Tuberculosis , Animales , Argentina/epidemiología , Humanos , América del Sur , Tuberculosis/epidemiología , Tuberculosis/veterinaria
18.
BMC Public Health ; 20(1): 1809, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33246432

RESUMEN

BACKGROUND: Mathematical modelling of infectious diseases is a powerful tool for the design of management policies and a fundamental part of the arsenal currently deployed to deal with the COVID-19 pandemic. METHODS: We present a compartmental model for the disease where symptomatic and asymptomatic individuals move separately. We introduced healthcare burden parameters allowing to infer possible containment and suppression strategies. In addition, the model was scaled up to describe different interconnected areas, giving the possibility to trigger regionalized measures. It was specially adjusted to Mendoza-Argentina's parameters, but is easily adaptable for elsewhere. RESULTS: Overall, the simulations we carried out were notably more effective when mitigation measures were not relaxed in between the suppressive actions. Since asymptomatics or very mildly affected patients are the vast majority, we studied the impact of detecting and isolating them. The removal of asymptomatics from the infectious pool remarkably lowered the effective reproduction number, healthcare burden and overall fatality. Furthermore, different suppression triggers regarding ICU occupancy were attempted. The best scenario was found to be the combination of ICU occupancy triggers (on: 50%, off: 30%) with the detection and isolation of asymptomatic individuals. In the ideal assumption that 45% of the asymptomatics could be detected and isolated, there would be no need for complete lockdown, and Mendoza's healthcare system would not collapse. CONCLUSIONS: Our model and its analysis inform that the detection and isolation of all infected individuals, without leaving aside the asymptomatic group is the key to surpass this pandemic.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Epidemias/prevención & control , Pandemias/prevención & control , Aislamiento de Pacientes , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Argentina/epidemiología , Infecciones por Coronavirus/epidemiología , Humanos , Modelos Teóricos , Neumonía Viral/epidemiología
20.
Medicina (B Aires) ; 80(5): 417-424, 2020.
Artículo en Español | MEDLINE | ID: mdl-33048783

RESUMEN

This is a preliminary, multicenter, retrospective cohort study, including 272 consecutive patients with COVID-19 admitted to hospitals in Buenos Aires Province, between May 15th and July 1st, 2020, included in an expanded access program to convalescent plasma. Our objectives were to analyze mortality and its independent risk factors, and to assess the occurrence of a favorable evolution, defined as hospital discharge, or stay at the ward, or transfer from ICU to ward. Patients were stratified int o 4 subgroups: admission to the ward with pneumonia and/or oxygen requirement (WARD; n = 100); ICU admission (ICU; n = 87); ICU admission with requirement of mechanical ventilation (ICU-MV; n = 56), and ICU-MV plus septic shock (ICU-MV-SS; N = 29). Mortality at 28 days was 26.1% for the entire group, 14.0% for WARD group, 18.4% for ICU, 44.6% for ICU-MV, and 55.2% for ICU-MV-SS. Mean survival time (days) was 25.6 ± 0.6 (WARD); 25.3 ± 0.7 (ICU); 20.8 ± 1.2 (ICU-MV) and 18.2 ± 1.8 (ICU-MV-SS). Independent predictors of mortality were MV, septic shock and weight. A favorable evolution occurred in 81.4% of WARD patients; in 70.9% of ICU; in 39.6% of ICU-MV and in 27.6% of ICU-MV-SS patients. Severity of illness on admission, age, weight and heart rate were independently associated with evolution. No major adverse effects were recorded. The lack of a control group precluded the estimation of efficacy. However, our 26% mortality rate was higher than that of the treatment arm of clinical trials comparing plasma with usual treatment, which might be ascribed to higher proportion of patients with MV and septic shock in our cohort.


Asunto(s)
Infecciones por Coronavirus/terapia , Pandemias , Neumonía Viral/terapia , Adulto , Anciano , Argentina/epidemiología , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Inmunización Pasiva/métodos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Estudios Retrospectivos , Resultado del Tratamiento
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