Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study.

INTRODUCTION: The EXAcerbations of Chronic obstructive lung disease (COPD) and their OutcomeS (EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries. METHODS: EXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU. RESULTS: In total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1 from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109 cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU. DISCUSSION: The findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.

Immunogenicity, Reactogenicity, and Safety of AS01E-adjuvanted RSV Prefusion F Protein-based Candidate Vaccine (RSVPreF3 OA) When Co-administered With a Seasonal Quadrivalent Influenza Vaccine in Older Adults: Results of a Phase 3, Open-Label, Randomized Controlled Trial.

BACKGROUND: Co-administration of vaccines against respiratory syncytial virus (RSV) and influenza can be considered given their overlapping seasonality, and may increase vaccine uptake and compliance. In this phase 3, open-label, randomized study, we evaluated the immunogenicity, reactogenicity, and safety of the AS01E-adjuvanted RSV prefusion F protein-based candidate vaccine (RSVPreF3 OA) when co-administered with a seasonal quadrivalent influenza vaccine (FLU-QIV) in older adults. METHODS: Participants aged ≥60 years (randomized 1:1) received either RSVPreF3 OA and FLU-QIV simultaneously on day 1 (Co-Ad group) or FLU-QIV on day 1 followed by RSVPreF3 OA on day 31 (sequential administration [SA] group). The co-primary objectives were to demonstrate noninferiority of RSVPreF3 OA in terms of RSV-A neutralization geometric mean titer (GMT) ratio and FLU-QIV in terms of hemagglutination inhibition GMT ratio for each FLU-QIV strain, when co-administered versus when administered alone at 1-month post-vaccination. Noninferiority was demonstrated if the upper limit of the 95% confidence interview of the group GMT ratio (SA/Co-Ad) was ≤1.5. Secondary descriptive objectives comprised additional immunogenicity assessments, reactogenicity, and safety. RESULTS: Of the 885 participants who received one dose of the study vaccines, 837 were included in the per protocol set. Demographic and baseline characteristics were balanced between the groups. Both co-primary objectives were met for both vaccines. Reported adverse events in both groups were mild-to-moderate, with a low frequency of grade 3 events. CONCLUSIONS: Data from this study demonstrate that RSVPreF3 OA can be co-administered with FLU-QIV. Co-administration is well tolerated, with an acceptable safety profile. CLINICALTRIALS.GOV REGISTRATION: NCT04841577.

Effect of Altitude on Respiratory Functional Status in COVID-19 Survivors: Results from a Latin American Cohort-FIRCOV.

Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort-FIRCOV. High Alt Med Biol 24:37-48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation.

Latin American Registry of Idiopathic Pulmonary Fibrosis (REFIPI): Clinical Characteristics, Evolution and Treatment

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible and frequently fatal disease. Currently there are national and multinational registries in Europe, United States, Australia and China to better understand the magnitude of the problem and the characteristics of the IPF patients. However, there are no national or regional registries in Latin America, so the objective of this study was to carry out a Latin American registry that would allow the identification of IPF patients in our region. Methodology: A system consisting of 3 levels of control was designed, ensuring that patients met the diagnostic criteria for IPF according to international guidelines ATS/ERS/ALAT/JRS 2011. Demographic, clinical, serological, functional, tomographic, histological and treatment variables were recorded through a digital platform. Results: 761 IPF patients from 14 Latin American countries were included for analysis, 74.7% were male, with a mean age of 71.9+8.3 years. In general there was a long period of symptoms before definitive diagnosis (median 1 year). In functional tests, an average reduction of FVC (70.9%) and DLCO (53.7%) was detected. 72% received at least one antifibrotic drug (pirfenidone or nintedanib) and 11.2% of the patients had an acute exacerbation, of which 38 (45.2%) died from this cause. Conclusions: Like other registries, we found that there is difficulty in the recognition and excessive delay in the diagnosis of IPF in Latin America. Most of the patients in REFIPI received antifibrotics; these were well tolerated and associated with fewer adverse events than those reported in clinical trials. (AU)

Presión positiva en vía aérea y cánula de alto flujo en el tratamiento de insuficiencia respiratoria por COVID-19, en unidades de cuidados respiratorios especiales, de dos hospitales de referencia en la República de Panamá

Introducción: En Panamá, así como en otras partes del mundo como España e Italia, se crearon Unidades de Cuidados Respiratorios Especiales para brindar soporte no invasivo a pacientes con insuficiencia respiratoria por neumonía por SARS-COV-2. En este trabajo se describen las características demográfica y clínicas de los pacientes que utilizaron ventilación no invasiva y/o cánula de alto flujo.  Material y métodos: El diseño del estudio fue prospectivo, observacional y descriptivo en dos hospitales de referencia en Panamá. Los pacientes firmaron un consentimiento informado y se procedió a llenar un cuestionario diario sobre las características demográficas y variables clínicas diarias.  Resultados: Se logró recolectar datos de 173 paciente, 60.69% correspondió al sexo masculino y se encontraban en una media de edad de 59 años, la comorbilidad más común fue la hipertensión arterial. El 88.75% de los pacientes tuvieron un NEWS 2 por arriba de 5 que indicaba mayor vigilancia por riesgo medio de paciente crítico, tanto la VMNI como el CAF tuvieron buenos resultados, 60% y 80% respectivamente. Conclusión: Nuestro estudio nos da luces sobre las características de los pacientes con insuficiencia respiratoria que requirieron dispositivos no invasivos y nos permite observar la evolución de estos en un contexto donde los recursos son limitados para terapia en cuidados intensivos. (provisto por Infomedic International)

Introduction: In Panama, as in other parts of the world, Special Respiratory Care Units were created to provide non-invasive support to patients with respiratory failure due to SARS-COV-2 pneumonia. In this work, the demographic and clinical characteristics of the patients who used non-invasive ventilation and/or high-flow cannula are described. Material and method: The study design was prospective, observational and descriptive in two Reference Hospitals in Panama. The patients signed an informed consent and proceeded to fill out a daily questionnaire on demographic characteristics and daily clinical variables. Results: We included 173 patients, 60.69% were male and had a mean age of 59 years, and the most common comorbidity was hypertension. In the evaluation of the risks, the 88.75% had a NEWS 2 above 5 that indicated greater vigilance due to the medium risk of a critical patient, both NIV and HFC had good results in 60% and 80% respectively. Conclusion: Our study sheds light on the characteristics of patients with respiratory failure who required non-invasive devices and allows us to observe their evolution in a context where resources are limited for intensive care therapy. (provided by Infomedic International)

Latin American Registry of Idiopathic Pulmonary Fibrosis (REFIPI): Clinical Characteristics, Evolution and Treatment.

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible and frequently fatal disease. Currently there are national and multinational registries in Europe, United States, Australia and China to better understand the magnitude of the problem and the characteristics of the IPF patients. However, there are no national or regional registries in Latin America, so the objective of this study was to carry out a Latin American registry that would allow the identification of IPF patients in our region. METHODOLOGY: A system consisting of 3 levels of control was designed, ensuring that patients met the diagnostic criteria for IPF according to international guidelines ATS/ERS/ALAT/JRS 2011. Demographic, clinical, serological, functional, tomographic, histological and treatment variables were recorded through a digital platform. RESULTS: 761 IPF patients from 14 Latin American countries were included for analysis, 74.7% were male, with a mean age of 71.9+8.3 years. In general there was a long period of symptoms before definitive diagnosis (median 1 year). In functional tests, an average reduction of FVC (70.9%) and DLCO (53.7%) was detected. 72% received at least one antifibrotic drug (pirfenidone or nintedanib) and 11.2% of the patients had an acute exacerbation, of which 38 (45.2%) died from this cause. CONCLUSIONS: Like other registries, we found that there is difficulty in the recognition and excessive delay in the diagnosis of IPF in Latin America. Most of the patients in REFIPI received antifibrotics; these were well tolerated and associated with fewer adverse events than those reported in clinical trials.

Fibrosis pulmonar idiopática. Características clínicas de un registro en Panamá. 2017-2020

Introducción: La fibrosis pulmonar idiopática es una enfermedad rara, asociada al envejecimiento, con una alta tasa de mortalidad entre los 2.5 a 3 años. El diagnóstico se realiza con la sospecha clínica y la confirmación del patrón de neumonía intersticial usual, en tomografía del tórax o en biopsia pulmonar; el tratamiento actual se basa en fármacos anti fibróticos. Material y método: Se llevó a cabo un estudio descriptivo y prospectivo tipo registro, de pacientes con fibrosis pulmonar idiopática, que estuviesen en seguimiento por médicos especialistas en neumología en 4 consultorios privados de la ciudad de Panamá entre el 2017 y el 2020. Resultado: Se evaluaron 32 pacientes, edad media de 69 años (rango 53 ­ 91); 18/32 (56.3%) fueron masculinos, y de estos, 16/18 (88.9%) eran fumadores. Los crepitantes tipo velcro subescapulares se encontraron en 29/32 (90.6%). El patrón de neumonía intersticial usual en tomografía se encontró en 30/32 (93.7%), y 2/32 (6.3%) en biopsia. Los medicamentos anti fibróticos fueron usados en 6/32 (18.6%); el 50% usó nintedanib y el 50% pirfenidona. Fallecieron 4/32 (12.5%) pacientes en el periodo de estudio. Conclusión: La fibrosis pulmonar idiopática es frecuente en mayores de 50 años, principalmente varones, con historial de tabaquismo y reflujo gastroesofágico. Los crepitantes tipo velcro subescapulares son un hallazgo frecuente. El diagnóstico se realizó en su mayoría con tomografía de tórax de alta resolución; la difusión de monóxido de carbono y la saturación en la caminata de 6 minutos son las pruebas funcionales más alteradas. Menos de un tercio de los pacientes recibe tratamiento con anti fibróticos. (provisto por Infomedic International)

Introduction: Idiopathic pulmonary fibrosis is a rare disease, associated with aging, with a high mortality rate between 2.5 to 3 years. Diagnosis is made with clinical suspicion and confirmation of the usual interstitial pneumonia pattern in chest tomography or lung biopsy; current treatment is based on antifibrotic drugs. Methods: A descriptive and prospective registry-type study was carried out on patients with idiopathic pulmonary fibrosis who were being followed up by pulmonology specialists in 4 private practices in Panama City between 2017 and 2020. Results: 32 patients were evaluated, mean age 69 years (range 53 - 91); 18/32 (56.3%) were male, and of these, 16/18 (88.9%) were smokers. Subscapularis velcro-type crackles were found in 29/32 (90.6%). The usual interstitial pneumonia pattern on CT was found in 30/32 (93.7%), and 2/32 (6.3%) on biopsy. Antifibrotic drugs were used in 6/32 (18.6%); 50% used nintedanib and 50% pirfenidone. Four/32 (12.5%) patients died during the study period. Conclusion: Idiopathic pulmonary fibrosis is frequent in patients older than 50 years, mainly males, with a history of smoking and gastroesophageal reflux. Subscapular Velcro-like crackles are a frequent finding. Diagnosis was mostly made with high-resolution chest CT; carbon monoxide diffusion and 6-minute walk saturation are the most altered functional tests. Less than one third of patients receive treatment with antifibrotic drugs. (provided by Infomedic International)

Determinación de zonas de riesgo al agua arsenical y prevalencia de hacre en Villa Belgrano, Tucumán, Argentina / Determination of zones exposed to Arsenical Water and CERHA prevalence in Villa Belgrano, Tucumán, Argentina

INTRODUCCION: En Tucumán la concentración de arsénico en agua fluctúa entre 0,1 y 0,01 ppm. El sistema de salud carece de registro de casos. OBJETIVOS: Elaborar un mapa de riesgo ambiental, estimar la prevalencia de hidroarsenicismo crónico regional endémico (HACRE) y explorar la relación entre la concentración de arsénico en agua y las manifestaciones clínicas en Villa Belgrano, Tucumán. METODOS: estudio transversal. Se analizaron todas las fuentes de agua y se seleccionaron aleatoriamente 119 personas adultas. Para la definición de caso de HACRE se utilizó un criterio diferente al de la Organización Mundial de la Salud (OMS) en concentración de arsénico en agua, orina y cabello y tiempo de consumo, siendo éste más sensible en el valor de corte de arsénico en el agua. Se consideró caso definido a quien había consumido agua con un nivel de arsénico mayor a 0,01 partes por millón(ppm) por más de 5 años y presentado más de 3 ug/g en cabello y/o más de 40 ug/g en orina, con clínica compatible. RESULTADOS: El 75% de las fuentes de agua tenían valores mayores a 0,01 ppm de arsénico. Con los criterios de la OMS, se registraron 51 casos probables y no hubo casos definidos. Según los criterios del estudio, hubo 3 casos definidos y una prevalencia del 2,6%. No se halló una asociación entre lesiones no cutáneas o cutáneas graves y valores mayores a 0,01 ppm. CONCLUSIONES: La prevalencia estimada según los criterios del estudio tuvo valores similares a los establecidos en la bibliografía bajo las condiciones en cuestión, aunque con otros criterios no comparables.(AU)

INTRODUCTION: In Tucumán, the arsenic concentration in water fluctuates between 0,1 and 0,01 ppm.The provincial health system does not have any record of cases. OBJECTIVES: To identify and create a map of environmental risk, estimating also chronic endemic regional hydroarsenicism(CERHA) prevalence in Villa Belgrano and exploring the relation between arsenic concentration in water and clinical manifestations. METHODS: A cross-sectional study was performed. All water sources were analyzed and 119 adults were randomly selected. The definition of case considered the own criteria, which differed from the ones of World Health Organization (WHO) regarding arsenic concentration in water, urine and hair as well as time of consumption. The study criteria is most sensible in arsenic water concentration. Those who had consumed water with more than 0.01 parts per million (ppm) for over 5 years and presented more than 3 ug/g in hair and/or more than 40 ug/gin urine with compatible clinical signs were considered as cases. RESULTS: 75 % of water sources had arsenic levels higher than 0.01 ppm. According to the WHO criteria, there were 51 probable cases and there was not any defined case. According to the study criteria, there were 3 defined cases with a prevalence of 2.6%. The study did not find an association between withnon-cutaneous or serious cutaneous injuries and arsenic levelin water higher than 0.01 ppm. CONCLUSIONS: The prevalence estimated according to the study criteria was similar to the one established in the bibliography under the same conditions, though with other criteria which are not comparable.(AU)

Determinación de zonas de riesgo al agua arsenical y prevalencia de hacre en Villa Belgrano, Tucumán, Argentina / Determination of zones exposed to Arsenical Water and CERHA prevalence in Villa Belgrano, Tucumán, Argentina

INTRODUCCION: En Tucumán la concentración de arsénico en agua fluctúa entre 0,1 y 0,01 ppm. El sistema de salud carece de registro de casos. OBJETIVOS: Elaborar un mapa de riesgo ambiental, estimar la prevalencia de hidroarsenicismo crónico regional endémico (HACRE) y explorar la relación entre la concentración de arsénico en agua y las manifestaciones clínicas en Villa Belgrano, Tucumán. METODOS: estudio transversal. Se analizaron todas las fuentes de agua y se seleccionaron aleatoriamente 119 personas adultas. Para la definición de caso de HACRE se utilizó un criterio diferente al de la Organización Mundial de la Salud (OMS) en concentración de arsénico en agua, orina y cabello y tiempo de consumo, siendo éste más sensible en el valor de corte de arsénico en el agua. Se consideró caso definido a quien había consumido agua con un nivel de arsénico mayor a 0,01 partes por millón(ppm) por más de 5 años y presentado más de 3 ug/g en cabello y/o más de 40 ug/g en orina, con clínica compatible. RESULTADOS: El 75% de las fuentes de agua tenían valores mayores a 0,01 ppm de arsénico. Con los criterios de la OMS, se registraron 51 casos probables y no hubo casos definidos. Según los criterios del estudio, hubo 3 casos definidos y una prevalencia del 2,6%. No se halló una asociación entre lesiones no cutáneas o cutáneas graves y valores mayores a 0,01 ppm. CONCLUSIONES: La prevalencia estimada según los criterios del estudio tuvo valores similares a los establecidos en la bibliografía bajo las condiciones en cuestión, aunque con otros criterios no comparables.(AU)

INTRODUCTION: In Tucumán, the arsenic concentration in water fluctuates between 0,1 and 0,01 ppm.The provincial health system does not have any record of cases. OBJECTIVES: To identify and create a map of environmental risk, estimating also chronic endemic regional hydroarsenicism(CERHA) prevalence in Villa Belgrano and exploring the relation between arsenic concentration in water and clinical manifestations. METHODS: A cross-sectional study was performed. All water sources were analyzed and 119 adults were randomly selected. The definition of case considered the own criteria, which differed from the ones of World Health Organization (WHO) regarding arsenic concentration in water, urine and hair as well as time of consumption. The study criteria is most sensible in arsenic water concentration. Those who had consumed water with more than 0.01 parts per million (ppm) for over 5 years and presented more than 3 ug/g in hair and/or more than 40 ug/gin urine with compatible clinical signs were considered as cases. RESULTS: 75 % of water sources had arsenic levels higher than 0.01 ppm. According to the WHO criteria, there were 51 probable cases and there was not any defined case. According to the study criteria, there were 3 defined cases with a prevalence of 2.6%. The study did not find an association between withnon-cutaneous or serious cutaneous injuries and arsenic levelin water higher than 0.01 ppm. CONCLUSIONS: The prevalence estimated according to the study criteria was similar to the one established in the bibliography under the same conditions, though with other criteria which are not comparable.(AU)

Determinación de zonas de riesgo al agua arsenical y prevalencia de hacre en Villa Belgrano, Tucumán, Argentina / Determination of zones exposed to Arsenical Water and CERHA prevalence in Villa Belgrano, Tucumán, Argentina

INTRODUCCIÓN: En Tucumán la concentración de arsénico en agua fluctúa entre 0,1 y 0,01 ppm. El sistema de salud carece de registro de casos. OBJETIVOS: Elaborar un mapa de riesgo ambiental, estimar la prevalencia de hidroarsenicismo crónico regional endémico (HACRE) y explorar la relación entre la concentración de arsénico en agua y las manifestaciones clínicas en Villa Belgrano, Tucumán. MÉTODOS: estudio transversal. Se analizaron todas las fuentes de agua y se seleccionaron aleatoriamente 119 personas adultas. Para la definición de caso de HACRE se utilizó un criterio diferente al de la Organización Mundial de la Salud (OMS) en concentración de arsénico en agua, orina y cabello y tiempo de consumo, siendo éste más sensible en el valor de corte de arsénico en el agua. Se consideró caso definido a quien había consumido agua con un nivel de arsénico mayor a 0,01 partes por millón(ppm) por más de 5 años y presentado más de 3 ug/g en cabello y/o más de 40 ug/g en orina, con clínica compatible. RESULTADOS: El 75% de las fuentes de agua tenían valores mayores a 0,01 ppm de arsénico. Con los criterios de la OMS, se registraron 51 casos probables y no hubo casos definidos. Según los criterios del estudio, hubo 3 casos definidos y una prevalencia del 2,6%. No se halló una asociación entre lesiones no cutáneas o cutáneas graves y valores mayores a 0,01 ppm. CONCLUSIONES: La prevalencia estimada según los criterios del estudio tuvo valores similares a los establecidos en la bibliografía bajo las condiciones en cuestión, aunque con otros criterios no comparables.

INTRODUCTION: In Tucumán, the arsenic concentration in water fluctuates between 0,1 and 0,01 ppm.The provincial health system does not have any record of cases. OBJECTIVES: To identify and create a map of environmental risk, estimating also chronic endemic regional hydroarsenicism(CERHA) prevalence in Villa Belgrano and exploring the relation between arsenic concentration in water and clinical manifestations. METHODS: A cross-sectional study was performed. All water sources were analyzed and 119 adults were randomly selected. The definition of case considered the own criteria, which differed from the ones of World Health Organization (WHO) regarding arsenic concentration in water, urine and hair as well as time of consumption. The study criteria is most sensible in arsenic water concentration. Those who had consumed water with more than 0.01 parts per million (ppm) for over 5 years and presented more than 3 ug/g in hair and/or more than 40 ug/gin urine with compatible clinical signs were considered as cases. RESULTS: 75 % of water sources had arsenic levels higher than 0.01 ppm. According to the WHO criteria, there were 51 probable cases and there was not any defined case. According to the study criteria, there were 3 defined cases with a prevalence of 2.6%. The study did not find an association between withnon-cutaneous or serious cutaneous injuries and arsenic levelin water higher than 0.01 ppm. CONCLUSIONS: The prevalence estimated according to the study criteria was similar to the one established in the bibliography under the same conditions, though with other criteria which are not comparable.

Determinación de zonas de riesgo al agua arsenical y prevalencia de hidroarsenicismo crónico regional endémico en Villa Belgrano, Tucumán / Determination of zones exposed to arsenic water and chronic endemic regional hydroarsenicism prevalence in Villa Belgrano, Tucumán

INTRODUCCION: El hidroarsenicismo crónico regional endémico (HACRE) es una enfermedad causada por el consumo de agua contaminada con arsénico. En Tucumán, la concentración de arsénico en agua potable fluctúa entre 0,1 y 0,01 ppm. Aunque existen estudios, el sistema provincial de salud no cuenta con un registro de casos.OBJETIVO: Identificar zonas de riesgo y generar un mapa ambiental. Estimar la prevalencia de HACRE en Villa Belgrano. Explorar la relación de arsénico en agua con manifestaciones clínicas.METODOS: Se realizó un estudio de corte transversal. Se analizaron las fuentes de agua y se seleccionaron aleatoriamente 119 adultos para un estudio clínico y de biomarcadores. Los valores de referencia fueron 40 Ag/g para orina y 3 Ag/g para pelo. Se consideró caso a quien había consumido agua con arsénico con más de 0,01 ppm por más de 5 años y presentado más de 1 Ag/g en pelo y/o 40Ag/g en orina y clínica compatible. Según la Organización Mundial de la Salud (OMS), se observó si la concentración en agua difería en más de 0,05 ppm por más de 6 meses y si el nivel en orina era mayor a 50 Ag/l. Se utilizó Chi2 para comparar proporciones. En todos los casos se consideró un nivel de significancia de p=0,05.RESULTADOS: EL 75% de las fuentes de agua tenían más de 0,01 ppm de arsénico. Según el criterio de la OMS, hubo 51 casos probables y ninguno definido. Según el estudio, hubo 3 casos definidos. De los 119 pacientes estudiados, 54 (45%) presentaron manifestaciones dermatológicas. Los valores en pelo fueron siempre menores a 1 Ag/g. La prevalencia fue de 2,6%, con IC 95% (-0,34 - 5,47). No hubo casos definidos según el criterio de la OMS. No se halló asociación con lesiones cutáneas graves, manifestaciones sistémicas ni niveles elevados de arsénico en orina/pelo o niveles de agua superiores a 0,01 ppm.CONCLUSIONES: Sería importante considerar el enfoque empelado en este estudio para replicarlo en distintas áreas de la provincia expuestas al agua arsenical.

INTRODUCTION: The chronic endemic regional hydroarsenicism (CERHA) is a disease caused by the consumption of arsenic-contaminated water. In Tucumán, the concentration of arsenic in drinkable water is betweer 0.1 and 0.01 ppm. Although there were studies, the provincial health system does not have a record of cases.OBJECTIVE: To identify zones of risk and create a map, estimating also CERHA prevalence and exploring the relation between arsenic in water and clinical manifestations.METHODS: A cross-sectional study was performed. The water sources were analyzed and 119 adults were randomly selected for clinical and biomarker trials. The reference values were 40Ag/g for urine and 3Ag/g for hair. Those who had consumed water with more than 0.01 ppm for over 5 years and presented more than 1Ag/g in hair and/or 40Ag/g in urine with compatible clinical signs were considered as cases. According to the criteria of World Health Organization (WHO), it was considered if the concentration in watter differed by more than 0.05 ppm for over 6 months and if arsenic level in urine was higher than 50Ag/l. Chi2 was used to compare proportions. All the cases considered a level of significance of p=0.05. RESULTS: 75% of water sources had arsenic levels higher than 0.01 ppm. According to the WHO criteria, there were 51 probable cases and there was not any defined case. According to the study criteria, there were 3 defined cases. Of 119 studied patients, 54 (45%) showed some dermatological manifestations. The values in hair were always lower than 1 Ag/g. The prevalence was 2.6%, with CI 95% (-0.34 - 5.47). There was not any case defined according to WHO. The study did not find an association with serious cutaneous injuries, systemic manifestations, high arsenic level in urine/hair or arsenic level in water higher than 0.01 ppm.CONCLUSIONS: It would be important to consider the approach of this study to implement it in other provincial locations exposed to high arsenic concentrations.

Determinación de zonas de riesgo al agua arsenical y prevalencia de hidroarsenicismo crónico regional endémico en Villa Belgrano, Tucumán / Determination of zones exposed to arsenic water and chronic endemic regional hydroarsenicism prevalence in Villa Belgrano, Tucumán

INTRODUCCION: El hidroarsenicismo crónico regional endémico (HACRE) es una enfermedad causada por el consumo de agua contaminada con arsénico. En Tucumán, la concentración de arsénico en agua potable fluctúa entre 0,1 y 0,01 ppm. Aunque existen estudios, el sistema provincial de salud no cuenta con un registro de casos.OBJETIVO: Identificar zonas de riesgo y generar un mapa ambiental. Estimar la prevalencia de HACRE en Villa Belgrano. Explorar la relación de arsénico en agua con manifestaciones clínicas.METODOS: Se realizó un estudio de corte transversal. Se analizaron las fuentes de agua y se seleccionaron aleatoriamente 119 adultos para un estudio clínico y de biomarcadores. Los valores de referencia fueron 40 Ag/g para orina y 3 Ag/g para pelo. Se consideró caso a quien había consumido agua con arsénico con más de 0,01 ppm por más de 5 años y presentado más de 1 Ag/g en pelo y/o 40Ag/g en orina y clínica compatible. Según la Organización Mundial de la Salud (OMS), se observó si la concentración en agua difería en más de 0,05 ppm por más de 6 meses y si el nivel en orina era mayor a 50 Ag/l. Se utilizó Chi2 para comparar proporciones. En todos los casos se consideró un nivel de significancia de p=0,05.RESULTADOS: EL 75% de las fuentes de agua tenían más de 0,01 ppm de arsénico. Según el criterio de la OMS, hubo 51 casos probables y ninguno definido. Según el estudio, hubo 3 casos definidos. De los 119 pacientes estudiados, 54 (45%) presentaron manifestaciones dermatológicas. Los valores en pelo fueron siempre menores a 1 Ag/g. La prevalencia fue de 2,6%, con IC 95% (-0,34 - 5,47). No hubo casos definidos según el criterio de la OMS. No se halló asociación con lesiones cutáneas graves, manifestaciones sistémicas ni niveles elevados de arsénico en orina/pelo o niveles de agua superiores a 0,01 ppm.CONCLUSIONES: Sería importante considerar el enfoque empelado en este estudio para replicarlo en distintas áreas de la provincia expuestas al agua arsenical.

INTRODUCTION: The chronic endemic regional hydroarsenicism (CERHA) is a disease caused by the consumption of arsenic-contaminated water. In Tucumán, the concentration of arsenic in drinkable water is betweer 0.1 and 0.01 ppm. Although there were studies, the provincial health system does not have a record of cases.OBJECTIVE: To identify zones of risk and create a map, estimating also CERHA prevalence and exploring the relation between arsenic in water and clinical manifestations.METHODS: A cross-sectional study was performed. The water sources were analyzed and 119 adults were randomly selected for clinical and biomarker trials. The reference values were 40Ag/g for urine and 3Ag/g for hair. Those who had consumed water with more than 0.01 ppm for over 5 years and presented more than 1Ag/g in hair and/or 40Ag/g in urine with compatible clinical signs were considered as cases. According to the criteria of World Health Organization (WHO), it was considered if the concentration in watter differed by more than 0.05 ppm for over 6 months and if arsenic level in urine was higher than 50Ag/l. Chi2 was used to compare proportions. All the cases considered a level of significance of p=0.05. RESULTS: 75% of water sources had arsenic levels higher than 0.01 ppm. According to the WHO criteria, there were 51 probable cases and there was not any defined case. According to the study criteria, there were 3 defined cases. Of 119 studied patients, 54 (45%) showed some dermatological manifestations. The values in hair were always lower than 1 Ag/g. The prevalence was 2.6%, with CI 95% (-0.34 - 5.47). There was not any case defined according to WHO. The study did not find an association with serious cutaneous injuries, systemic manifestations, high arsenic level in urine/hair or arsenic level in water higher than 0.01 ppm.CONCLUSIONS: It would be important to consider the approach of this study to implement it in other provincial locations exposed to high arsenic concentrations.