Safety and effectiveness of COVID-19 SPUTNIK V vaccine in dialysis patients.

INTRODUCTION: Given the vulnerability of chronic kidney disease individuals to SARS-CoV-2, nephrology societies have issued statements calling for prioritization of these patients for vaccination. It is not yet known whether COVID-19 vaccines grant the same high level of protection in patients with kidney disease compared to the non-dialysis population. The aims of this study were to evaluate the safety - measured by the adverse events potentially attributed to vaccines (ESAVI) - and the effectiveness - evaluated by the presence of antibodies - in dialysis patients immunized with the COVID-19 Sputnik V vaccine. METHODS: multicenter, observational and analytical study of a prospective cohort of hemodialysis patients from the Ciudad Autónoma de Buenos Aires participating in an official vaccination program. Dialysis requiring individuals older than 18 years, who received both components of the COVID-19 vaccine were included. RESULTS: Data from 491 patients were included in the safety analysis. ESAVI with either the first or second component was detected in 186 (37.9%, 95% CI 33.6%-42.3%). Effectiveness analysis measuring antibodies levels against SARS-CoV-2 were performed in 102 patients; 98% presented these IgG antibodies at day 21 after the second component. In patients with COVID-19 prior to vaccination, antibodies at day 21 after the first component reached almost the highest levels compared to patients without previous COVID-19, but IgG rise among patients with previous COVID-19 was lower than in those without this previous disease. CONCLUSION: The Sputnik V vaccine has been shown to be safe and effective in this patient's population.

Introducción: Dada la vulnerabilidad al SARS-CoV-2 de las personas con enfermedad renal crónica, las sociedades de nefrología han emitido declaraciones pidiendo priorizar a estos pacientes para la vacunación. Aún no se sabe si las vacunas COVID-19 confieren el mismo nivel de protección en pacientes con enfermedad renal. Los objetivos de este estudio fueron evaluar la seguridad, medida por eventos supuestamente atribuidos a las vacunas (ESAVI) y la efectividad, evaluada por la presencia de anticuerpos en pacientes en diálisis inmunizados con la vacuna COVID-19 Sputnik V. Métodos: estudio multicéntrico, observacional y analítico de una cohorte prospectiva de pacientes en hemodiálisis, en la Ciudad Autónoma de Buenos Aires, con plan de vacunación. Se incluyeron pacientes mayores de 18 años en diálisis que recibieron ambos componentes de la vacuna COVID-19. Resultados: 491 pacientes fueron incluidos en el análisis de seguridad. Se detectó ESAVI con el primer o el segundo componente en 186 (37.9% IC 95%: 33.6%-42.3%). La efectividad medida por presencia de anticuerpos IgG contra SARS-Cov-2 se realizó en 102 pacientes, 98% presentaba IgG contra SARS-CoV-2, 21 días después del segundo componente. En pacientes con COVID-19 previo a la vacunación, los anticuerpos al día 21 del primer componente alcanzaron niveles casi mayores que en aquellos que no habían sufrido COVID-19, aunque el aumento de los niveles a los 21 días del segundo componente fue menor que en los pacientes sin COVID-19 previo. Conclusión: Los pacientes en diálisis constituyen una población vulnerable para la infección por SARS-CoV-2, por lo tanto, más allá de las recomendaciones implementadas por las unidades de diálisis, la vacunación completa es mandatoria. Se ha demostrado que la vacuna Sputnik V es segura y eficaz en esta población de pacientes.

Safety and effectiveness of COVID-19 SPUTNIK V vaccine in dialysis patients / Seguridad y efectividad de vacuna COVID-19 SPUTNIK V en pacientes en diálisis

Abstract Introduction: Given the vulnerability of chronic kidney disease individuals to SARS-CoV-2, nephrology societies have issued statements calling for prioritization of these patients for vaccination. It is not yet known whether COVID-19 vaccines grant the same high level of protection in patients with kidney disease compared to the non-dialysis population. The aims of this study were to evaluate the safety - measured by the adverse events potentially attributed to vaccines (ESAVI) - and the effectiveness - evaluated by the presence of antibodies - in dialysis patients immunized with the COVID-19 Sputnik V vaccine. Methods: multicenter, ob servational and analytical study of a prospective cohort of hemodialysis patients from the Ciudad Autónoma de Buenos Aires participating in an official vaccination program. Dialysis requiring individuals older than 18 years, who received both components of the COVID-19 vaccine were included. Results: Data from 491 patients were included in the safety analysis. ESAVI with either the first or second component was detected in 186 (37.9%, 95% CI 33.6%-42.3%). Effectiveness analysis measuring antibodies levels against SARS-CoV-2 were performed in 102 patients; 98% presented these IgG antibodies at day 21 after the second component. In patients with COVID-19 prior to vaccination, antibodies at day 21 after the first component reached almost the highest levels compared to patients without previous COVID-19, but IgG rise among patients with previous COVID-19 was lower than in those without this previous disease. Conclusion: The Sputnik V vaccine has been shown to be safe and effective in this patient's population.

Resumen Introducción: Dada la vulnerabilidad al SARS-CoV-2 de las personas con enfermedad renal crónica, las sociedades de nefrología han emitido declaraciones pidiendo priorizar a estos pacientes para la vacunación. Aún no se sabe si las vacunas COVID-19 confieren el mismo nivel de protección en pacientes con enfermedad renal. Los objetivos de este estudio fueron evaluar la seguridad, medida por eventos supuestamente atribuidos a las vacunas (ESAVI) y la efectividad, evaluada por la presencia de anticuerpos en pacientes en diálisis inmuniza dos con la vacuna COVID-19 Sputnik V. Métodos: estudio multicéntrico, observacional y analítico de una cohorte prospectiva de pacientes en hemodiálisis, en la Ciudad Autónoma de Buenos Aires, con plan de vacunación. Se incluyeron pacientes mayores de 18 años en diálisis que recibieron ambos componentes de la vacuna COVID-19. Resultados: 491 pacientes fueron incluidos en el análisis de seguridad. Se detectó ESAVI con el primer o el segundo componente en 186 (37.9% IC 95%: 33.6%-42.3%). La efectividad medida por presencia de anticuerpos IgG contra SARS-Cov-2 se realizó en 102 pacientes, 98% presentaba IgG contra SARS-CoV-2, 21 días después del segundo componente. En pacientes con COVID-19 previo a la vacunación, los anticuerpos al día 21 del primer componente alcanzaron niveles casi mayores que en aquellos que no habían sufrido COVID-19, aunque el aumento de los niveles a los 21 días del segundo componente fue menor que en los pacientes sin COVID-19 previo. Conclusión: Los pacientes en diálisis constituyen una población vulnerable para la infección por SARS-CoV-2, por lo tanto, más allá de las recomendaciones implementadas por las unidades de diálisis, la vacunación completa es mandatoria. Se ha demostrado que la vacuna Sputnik V es segura y eficaz en esta población de pacientes.

Immunogenicity induced by the use of alternative vaccine platforms to deal with vaccine shortages in a low- to middle-income country: Results of two randomized clinical trials.

BACKGROUND: Shortages of component two of Sputnik V vaccine (rAd5) are delaying the possibility of achieving full immunisation. The immunogenic response associated with the use of alternative schemes to complete the scheme was not explored. METHODS: We did two non-inferiority randomized clinical trials with outcomes measures blinded to investigators on adults aged 21-65 years, vaccinated with a single dose of rAd26 ≥ 30 days before screening and no history of SARS-CoV-2. Participants were assigned (1:1:1:1:1) to receive either rAd5; ChAdOx1; rAd26; mRNA-1273 or BBIBP-CorV. The primary endpoint was the geometric mean ratio (GMR) of SARS-CoV-2 anti-spike IgG concentration at 28 days after the second dose, when comparing rAd26/rAd5 with rAd26/ChAdOx1, rAd26/rAd26, rAd26/mRNAmRNA-1273 and rAd26/BBIBP-CorV. Serum neutralizing capacity was evaluated using wild type SARS-CoV-2 reference strain 2019 B.1. The safety outcome was 28-day rate of serious adverse. The primary analysis included all participants who received ≥ 1 dose. The studies were registered with NCT04962906 and NCT05027672. Both trials were conducted in Buenos Aires, Argentina. FINDINGS: Between July 6 and August 3, 2021, 540 individuals (age 56·7 [SD 7·3]; 243 (45%) women) were randomly assigned to received rAd5 (n=150); ChAdOx1 (n=150); rAd26 (N=87); mRNAmRNA-1273 (n=87) or BBIBP-CorV (n=65). 524 participants completed the study. As compared with rAd26/rAd5 (1·00), the GMR (95%CI) at day 28 was 0·65 (0·51-0·84) among those who received ChAdOx1; 0·47 (0·34-0·66) in rAd5; 3·53 (2·68-4·65) in mRNA-1273 and 0·23 (0·16-0·33) in BBIBP-CorV. The geometric mean (IU/ml) from baseline to day 28 within each group increased significantly with ChAdOx1 (4·08 (3·07-5·43)); rAd26 (2·69 (1·76-4·11)); mRNA-1273 (21·98 (15·45-31·08)) but not in BBIBP-CorV (1·22 (0·80-1·87)). INTERPRETATION: Except for mRNA-1273 which proved superior, in all other alternatives non-inferiority was rejected. Antibody concentration increased in all non-replicating viral vector and RNA platforms. FUNDING: The trials were supported (including funding, material support in the form of vaccines and testing supplies) by the Buenos Aires City Government.

Evaluation of a COVID-19 Vaccine Campaign and SARS-CoV-2 Infection and Mortality Among Adults Aged 60 Years And Older in a Middle-Income Country.

Importance: Although there are reports of COVID-19 vaccine implementation in real-world populations, these come from high-income countries or from experience with messenger RNA technology vaccines. Data on outcomes of vaccine deployment in low- or middle-income countries are lacking. Objective: To assess whether the pragmatic application of the 3 COVID-19 vaccines available in Argentina, 2 of which have no reports of evaluation in real-world settings to date, were associated with a reduction in morbidity, all-cause mortality, and mortality due to COVID-19. Design, Setting, and Participants: This cohort study used individual and ecological data to explore outcomes following vaccination with rAd26-rAd5, ChAdOx1, and BBIBP-CorV. To correct for differences in exposure times, results are shown using incidence density per 100 000 person-days from the start of the vaccination campaign (December 29, 2020) to the occurrence of an event or the end of follow-up (May 15, 2021). Participants included 663 602 people aged at least 60 years residing in the city of Buenos Aires, Argentina. Statistical analysis was performed from June 1 to June 15, 2021. Main Outcomes and Measures: Diagnosis of COVID-19 confirmed by reverse transcription-polymerase chain reaction, death from all causes, and death within 30 days of a diagnosis of COVID-19. Poisson regression models were fitted to estimate associations with all 3 outcomes. Results: Among 663 602 residents of the city of Buenos Aires included in the study, 540 792 (81.4%) were vaccinated with at least 1 dose, with 457 066 receiving 1 dose (mean [SD] age, 74.5 (8.9) years; 61.5% were female [n = 281 284]; 68.0% [n = 310 987] received the rAd26-rAd5 vaccine; 29.5% [n = 135 036] received ChAdOx1; 2.4% [n = 11 043] received BBIBP-CorV) and 83 726 receiving 2 doses (mean [SD] age, 73.4 [6.8] years; 63.5% were female [n = 53 204]). The incidence density of confirmed COVID-19 was 36.25 cases/100 000 person-days (95% CI, 35.80-36.70 cases/100 000 person-days) among those who did not receive a vaccine, 19.13 cases/100 000 person-days (95% CI, 18.63-19.62 cases/100 000 person-days) among those who received 1 dose, and 4.33 cases/100 000 person-days (95% CI, 3.85-4.81 cases/100 000 person-days) among those who received 2 doses. All-cause mortality was 11.74 cases/100 000 person-days (95% CI, 11.51-11.96 cases/100 000 person-days), 4.01 cases/100 000 person-days (95% CI, 3.78-4.24 cases/100 000 person-days) and 0.40 cases/100 000 person-days (95% CI, 0.26-0.55 cases/100 000 person-days). COVID-19-related-death rate was 2.31 cases/100 000 person-days (95% CI, 2.19-2.42 cases/100 000 person-days), 0.59 cases/100 000 person-days (95% CI, 0.50-0.67 cases/100 000 person-days), and 0.04 cases/100 000 person-days (95% CI, 0.0-0.09 cases/100 000 person-days) among the same groups. A 2-dose vaccination schedule was associated with an 88.1% (95% CI, 86.8%-89.2%) reduction in documented infection, 96.6% (95% CI, 95.3%-97.5%) reduction in all-cause death, and 98.3% (95% CI, 95.3%-99.4%) reduction in COVID-19-related death. A single dose was associated with a 47.2% (95% CI, 44.2%-50.1%) reduction in documented infection, 65.8% (95% CI, 61.7%-69.5%) reduction in all-cause death, and 74.5% (95% CI, 66%-80.8%) reduction in COVID-19-related death. Conclusions and Relevance: This study found that within the first 5 months after the start of the vaccination campaign, vaccination was associated with a significant reduction in COVID-19 infection as well as a reduction in mortality.

α-Hydroxy boron-enabled regioselective access to bifunctional halo-boryl alicyclic ethers and α-halo borons.

α-Hydroxy borons are an underutilized class of compounds and their only previous application involved oxidation into acylborons. Herein, we describe the synthesis of functionalized olefinic α-hydroxy borons and their utility to enable a novel and regioselective route to hitherto unknown bifunctional halo-boryl tetrahydrofurans/tetrahydropyrans and α-halo MIDA boronates. The orthogonally functionalized alicyclic ethers provided a building block-based approach for diversification of the tetrahydrofuran core.

Use of alternative care sites during the COVID-19 pandemic in the city of Buenos Aires, Argentina.

OBJECTIVES: In large cities, where a large proportion of the population live in poverty and overcrowding, orders to stay home to comply with isolation requirements are difficult to fulfil. In this article, the use of alternative care sites (ACSs) for the isolation of patients with confirmed COVID-19 or persons under investigation (PUI) in the City of Buenos Aires during the first wave of COVID-19 are described. STUDY DESIGN: This is a cross-sectional study. METHODS: All patients with COVID-19 and PUI with insufficient housing resources who could not comply with orders to stay home and who were considered at low clinical risk in the initial triage were referred to refurbished hotels in the City of Buenos Aires (Ciudad Autónoma de Buenos Aires [CABA]). ACSs were divided into those for confirmed COVID-19 patients and those for PUI. RESULTS: From March to August 2020, there were 58,143 reported cases of COVID-19 (13,829 of whom lived in slums) in the CABA. For COVID-19 positive cases, 62.1% (n = 8587) of those living in slums and 21.4% (n = 9498) of those living outside the slums were housed in an ACS. In total, 31.1% (n = 18,085) of confirmed COVID-19 cases were housed in ACSs. In addition, 7728 PUI were housed (3178 from the slums) in an ACS. The average length of stay was 9.0 ± 2.5 days for patients with COVID-19 and 1.6 ± 0.7 days for PUI. For the individuals who were housed in an ACS, 1314 (5.1%) had to be hospitalised, 56 were in critical care units (0.22%) and there were 27 deaths (0.1%), none during their stay in an ACS. CONCLUSIONS: Overall, about one-third of all people with COVID-19 were referred to an ACS in the CABA. For slum dwellers, the proportion was >60%. The need for hospitalisation was low and severe clinical events were rare. This strategy reduced the pressure on hospitals so their efforts could be directed to patients with moderate-to-severe disease.

Evaluation of the first level of care for tuberculosis control in Buenos Aires, Argentina.

OBJECTIVE: Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina. METHODS: Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants' perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from "No, not at all" (1 point) to "Yes, definitely" (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains. RESULTS: 83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NoS). The evaluated functions were perceived as inadequate. The TB-S group gave the lowest overall scores, not reaching 3 points in any domain. There were no significant differences in domains or overall scores between groups. Participants with TB gave lower scores in all domains, except in family-centered care, where they gave a significantly higher score than NoTB participants. The overall score without secondary domains was lower for TB participants than for the NoTB groups. CONCLUSIONS: According to the perception of participants with TB and without TB, primary health care functions are not satisfactory, either in slums or outside them.

COVID-19 among the inhabitants of the slums in the city of Buenos Aires: a population-based study.

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.

[Evaluation of the first level of care for tuberculosis control in Buenos Aires, ArgentinaAvaliação da atenção primária à saúde no controle da tuberculose em Buenos Aires, Argentina]. / Evaluación del primer nivel de atención para el control de la tuberculosis en Buenos Aires, Argentina.

OBJECTIVES: Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina. METHODS: Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants' perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from "No, not at all" (1 point) to "Yes, definitely" (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains. RESULTS: 83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NS). The evaluated functions were perceived as inadequate. The TB-S group gave the lowest overall scores, not reaching 3 points in any domain. There were no significant differences in domains or overall scores between groups. Participants with TB gave lower scores in all domains, except in family-centered care, where they gave a significantly higher score than NoTB participants. The overall score without secondary domains was lower for TB participants than for the NoTB groups. CONCLUSIONS: According to the perception of participants with TB and without TB, primary health care functions are not satisfactory, either in slums or outside them.

OBJETIVOS: Avaliar as funções da atenção primária à saúde da perspectiva de pacientes com tuberculose (TB) provenientes de comunidades desfavorecidas na cidade de Buenos Aires, Argentina. MÉTODOS: Estudo observacional transversal com pacientes adultos com ou sem TB (TB, NãoTB), residentes ou não de comunidades desfavorecidas (C, NãoC). Avaliamos as percepções dos participantes utilizando questionário Primary Care Assessment Tool-usuários (versão reduzida), que mede quatro dimensões principais (primeiro contato, longitudinalidade da atenção, coordenação entre serviços e integralidade), bem como algumas dimensões secundárias. Utilizamos uma escala de Likert de 4 pontos, variando de "definitivamente não" (1 ponto) a "definitivamente sim" (4 pontos). Considerou-se que pontuações ≥3 indicavam o cumprimento adequado das funções. Calculamos as médias para cada domínio e duas pontuações globais: com e sem domínios secundários. RESULTADOS: Ao todo, 83 participantes foram incluídos no estudo (20 TB-C, 21 TB-NãoC, 19 NãoTB-C e 23 NãoTB-NãoC). As funções avaliadas foram percebidas como inadequadas. O grupo TB-C apresentou a pontuação global mais baixa, não alcançando 3 pontos em nenhum domínio. Não houve diferenças significativas entre os grupos nos domínios nem na pontuação global. Os participantes com TB deram pontuações mais baixas em todos os domínios, exceto no enfoque familiar, no qual a pontuação foi significativamente mais alta que a dos participantes sem TB; a pontuação global sem domínios secundários foi mais baixa nos participantes com TB que nos sem TB. CONCLUSÕES: De acordo com as percepções dos participantes com e sem TB, as funções da atenção primária à saúde são insatisfatórias, tanto dentro como fora das comunidades desfavorecidas.

Evaluación del primer nivel de atención para el control de la tuberculosis en Buenos Aires, Argentina

[RESUMEN]. Objetivo. Evaluar las funciones de la atención primaria de salud desde la perspectiva de los pacientes con tuberculosis (TB) provenientes de villas de emergencia de la Ciudad Autónoma de Buenos Aires, Argentina. Métodos. Estudio observacional transversal con pacientes adultos con TB y sin TB (NoTB), residentes en villas de emergencia (V) y fuera de ellas (NoV). La percepción de los participantes se evaluó mediante el cuestionario Primary Care Assessment Tool-usuarios (versión abreviada) que mide cuatro dimensiones principales (primer contacto, longitudinalidad de los cuidados, coordinación entre servicios e integralidad) y algunas secundarias. Se utilizó una escala de Likert, desde “No, en absoluto” (1 punto) hasta “Sí, sin duda” (4 puntos). Puntajes ≥ 3 se consideraron como cumplimiento adecuado de las funciones. Se calcularon promedios para cada dominio y dos puntajes globales: con y sin dominios secundarios. Resultados. Se incluyeron 83 participantes (20 TB-V, 21 TB-NV, 19 NoTB-V y 23 NoTB-NV). Las funciones evaluadas se percibieron como no adecuadas. El grupo TB-V tuvo los puntajes globales más bajos y en ningún dominio alcanzó 3 puntos. No hubo diferencias significativas en los dominios ni los puntajes globales entre grupos. Los participantes con TB dieron menores puntajes en todos los dominios, excepto en enfoque familiar que fue significativamente mayor que los de los participantes NoTB; el puntaje global sin dominios secundarios fue menor en los participantes con TB que en los NoTB. Conclusiones. Según la percepción de los participantes con TB y sin TB, las funciones de la atención primaria de salud no son satisfactorias, tanto dentro de las villas de emergencia como fuera de ellas.

[ABSTRACT]. Objectives. Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina. Methods. Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants’ perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from “No, not at all” (1 point) to “Yes, definitely” (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains. Results. 83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NS). The evaluated functions were perceived as inadequate. The TB-S group gave the lowest overall scores, not reaching 3 points in any domain. There were no significant differences in domains or overall scores between groups. Participants with TB gave lower scores in all domains, except in family-centered care, where they gave a significantly higher score than NoTB participants. The overall score without secondary domains was lower for TB participants than for the NoTB groups. Conclusions. According to the perception of participants with TB and without TB, primary health care functions are not satisfactory, either in slums or outside them.

[RESUMO]. Objetivos. Avaliar as funções da atenção primária à saúde da perspectiva de pacientes com tuberculose (TB) provenientes de comunidades desfavorecidas na cidade de Buenos Aires, Argentina. Métodos. Estudo observacional transversal com pacientes adultos com ou sem TB (TB, NãoTB), residentes ou não de comunidades desfavorecidas (C, NãoC). Avaliamos as percepções dos participantes utilizando questionário Primary Care Assessment Tool-usuários (versão reduzida), que mede quatro dimensões principais (primeiro contato, longitudinalidade da atenção, coordenação entre serviços e integralidade), bem como algumas dimensões secundárias. Utilizamos uma escala de Likert de 4 pontos, variando de “definitivamente não” (1 ponto) a “definitivamente sim” (4 pontos). Considerou-se que pontuações ≥3 indicavam o cumprimento adequado das funções. Calculamos as médias para cada domínio e duas pontuações globais: com e sem domínios secundários. Resultados. Ao todo, 83 participantes foram incluídos no estudo (20 TB-C, 21 TB-NãoC, 19 NãoTB-C e 23 NãoTB-NãoC). As funções avaliadas foram percebidas como inadequadas. O grupo TB-C apresentou a pontuação global mais baixa, não alcançando 3 pontos em nenhum domínio. Não houve diferenças significativas entre os grupos nos domínios nem na pontuação global. Os participantes com TB deram pontuações mais baixas em todos os domínios, exceto no enfoque familiar, no qual a pontuação foi significativamente mais alta que a dos participantes sem TB; a pontuação global sem domínios secundários foi mais baixa nos participantes com TB que nos sem TB. Conclusões. De acordo com as percepções dos participantes com e sem TB, as funções da atenção primária à saúde são insatisfatórias, tanto dentro como fora das comunidades desfavorecidas.

Out-of-focus brain image detection in serial tissue sections.

BACKGROUND: A large part of image processing workflow in brain imaging is quality control which is typically done visually. One of the most time consuming steps of the quality control process is classifying an image as in-focus or out-of-focus (OOF). NEW METHOD: In this paper we introduce an automated way of identifying OOF brain images from serial tissue sections in large datasets (>1.5 PB). The method utilizes steerable filters (STF) to derive a focus value (FV) for each image. The FV combined with an outlier detection that applies a dynamic threshold allows for the focus classification of the images. RESULTS: The method was tested by comparing the results of our algorithm with a visual inspection of the same images. The results support that the method works extremely well by successfully identifying OOF images within serial tissue sections with a minimal number of false positives. COMPARISON WITH EXISTING METHODS: Our algorithm was also compared to other methods and metrics and successfully tested in different stacks of images consisting solely of simulated OOF images in order to demonstrate the applicability of the method to other large datasets. CONCLUSIONS: We have presented a practical method to distinguish OOF images from large datasets that include serial tissue sections that can be included in an automated pre-processing image analysis pipeline.

Evaluation of the first level of care for tuberculosis control in Buenos Aires, Argentina

[ABSTRACT]. Objective. Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina. Methods. Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants’ perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from “No, not at all” (1 point) to “Yes, definitely” (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains. Results. 83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NoS). The evaluated functions were perceived as inadequate. The TB-S group gave the lowest overall scores, not reaching 3 points in any domain. There were no significant differences in domains or overall scores between groups. Participants with TB gave lower scores in all domains, except in family-centered care, where they gave a significantly higher score than NoTB participants. The overall score without secondary domains was lower for TB participants than for the NoTB groups. Conclusions. According to the perception of participants with TB and without TB, primary health care functions are not satisfactory, either in slums or outside them.

[RESUMEN]. Objetivo. Evaluar las funciones de la atención primaria de salud desde la perspectiva de los pacientes con tuberculosis (TB) provenientes de villas de emergencia de la Ciudad Autónoma de Buenos Aires, Argentina. Métodos. Estudio observacional transversal con pacientes adultos con TB y sin TB (NoTB), residentes en villas de emergencia (V) y fuera de ellas (NoV). La percepción de los participantes se evaluó mediante el cuestionario Primary Care Assessment Tool-usuarios (versión abreviada) que mide cuatro dimensiones principales (primer contacto, longitudinalidad de los cuidados, coordinación entre servicios e integralidad) y algunas secundarias. Se utilizó una escala de Likert, desde “No, en absoluto” (1 punto) hasta “Sí, sin duda” (4 puntos). Puntajes ≥ 3 se consideraron como cumplimiento adecuado de las funciones. Se calcularon promedios para cada dominio y dos puntajes globales: con y sin dominios secundarios. Resultados. Se incluyeron 83 participantes (20 TB-S, 21 TB-NV, 19 NoTB-S y 23 NoTB-NoS). Las funciones evaluadas se percibieron como no adecuadas. El grupo TB-S tuvo los puntajes globales más bajos y en ningún dominio alcanzó 3 puntos. No hubo diferencias significativas en los dominios ni los puntajes globales entre grupos. Los participantes con TB dieron menores puntajes en todos los dominios, excepto en enfoque familiar que fue significativamente mayor que los de los participantes NoTB; el puntaje global sin dominios secundarios fue menor en los participantes con TB que en los NoTB. Conclusiones. Según la percepción de los participantes con TB y sin TB, las funciones de la atención primaria de salud no son satisfactorias, tanto dentro de las villas de emergencia como fuera de ellas.

[RESUMO]. Objetivos. Avaliar as funções da atenção primária à saúde da perspectiva de pacientes com tuberculose (TB) provenientes de comunidades desfavorecidas na cidade de Buenos Aires, Argentina. Métodos. Estudo observacional transversal com pacientes adultos com ou sem TB (TB, NãoTB), residentes ou não de comunidades desfavorecidas (C, NãoC). Avaliamos as percepções dos participantes utilizando questionário Primary Care Assessment Tool-usuários (versão reduzida), que mede quatro dimensões principais (primeiro contato, longitudinalidade da atenção, coordenação entre serviços e integralidade), bem como algumas dimensões secundárias. Utilizamos uma escala de Likert de 4 pontos, variando de “definitivamente não” (1 ponto) a “definitivamente sim” (4 pontos). Considerou-se que pontuações ≥3 indicavam o cumprimento adequado das funções. Calculamos as médias para cada domínio e duas pontuações globais: com e sem domínios secundários. Resultados. Ao todo, 83 participantes foram incluídos no estudo (20 TB-C, 21 TB-NãoC, 19 NãoTB-C e 23 NãoTB-NãoC). As funções avaliadas foram percebidas como inadequadas. O grupo TB-C apresentou a pontuação global mais baixa, não alcançando 3 pontos em nenhum domínio. Não houve diferenças significativas entre os grupos nos domínios nem na pontuação global. Os participantes com TB deram pontuações mais baixas em todos os domínios, exceto no enfoque familiar, no qual a pontuação foi significativamente mais alta que a dos participantes sem TB; a pontuação global sem domínios secundários foi mais baixa nos participantes com TB que nos sem TB. Conclusões. De acordo com as percepções dos participantes com e sem TB, as funções da atenção primária à saúde são insatisfatórias, tanto dentro como fora das comunidades desfavorecidas.

Analysis of the decrease in deaths due to coronary disease between 1995 and 2010. IMPACT CHD Argentina Study. / [Análisis del descenso de muertes por enfermedad coronaria entre 1995 y 2010. Estudio IMPACT CHD Argentina.]

Objetive: To quantify the contribution of risk factors and treatments in the reduction of mortality due to coronary heart disease in Argentina between 1995 and 2010. Results: We used the validated IMPACTCHD model integrating data on effectiveness, use of treatments and changes in the risk factors between 1995 and 2010 in people older than 25 years in Argentina. The difference between the coronary deaths observed and expected in 2010 was distributed between treatments and risk factors. Conclusions: One out of every two MPP due to coronary heart disease in Argentina between 1995 and 2010 was due to treatments and one third to the improvement of risk factors. The decrease in blood pressure, cholesterol and smoking was limited by increases in the prevalence of obesity, sedentary lifestyle and diabetes. This study was possible thanks to the collaborative work to the cardiovascular epidemiology.

Objetivos: Cuantificar la contribución de los factores de riesgo (FR) y de los tratamientos en el descenso de mortalidad por enfermedad coronaria en Argentina entre 1995 y 2010. Métodos: Utilizamos el modelo validado IMPACTCHD integrando datos de efectividad y utilización de tratamientos y cambios en los FR en 1995 y 2010 en mayores de 25 años en Argentina. La diferencia entre las muertes coronarias observadas y esperadas en el 2010 se distribuyó entre los tratamientos y los FR. Resultados: Entre 1995 y 2010 las tasas ajustadas de mortalidad por enfermedad coronaria descendieron 29,8% (8 500 muertes prevenidas o pospuestas - MPP). Las mejoras en los tratamientos explicaron un 49,9%, en su mayoría por prevención secundaria del infarto agudo de miocardio (8,2%); tratamiento antihipertensivo (11,9%) y para insuficiencia cardíaca (13,2%). Las mejoras en los FR explicaron 32,9% de las MPP: presión arterial sistólica 34,6%; colesterol total 12,8%; tabaquismo 6,8%. Se encontró un exceso de muertes debido al aumento de diabetes (9,4%), obesidad (6,9%) y sedentarismo (5%). Un 17,2% de las MPP no fue explicado por el modelo. Conclusiones: Una de cada dos MPP por enfermedad coronaria en Argentina entre 1995 y 2010 se debió a los tratamientos y un tercio a la mejora de los FR. El descenso de la presión arterial, colesterol y tabaquismo fue limitado por aumentos en la prevalencia de obesidad, sedentarismo y diabetes. Este trabajo fue posible gracias al trabajo colaborativo en pos de la epidemiología cardiovascular.

An active texture-based digital atlas enables automated mapping of structures and markers across brains.

Brain atlases enable the mapping of labeled cells and projections from different brains onto a standard coordinate system. We address two issues in the construction and use of atlases. First, expert neuroanatomists ascertain the fine-scale pattern of brain tissue, the 'texture' formed by cellular organization, to define cytoarchitectural borders. We automate the processes of localizing landmark structures and alignment of brains to a reference atlas using machine learning and training data derived from expert annotations. Second, we construct an atlas that is active; that is, augmented with each use. We show that the alignment of new brains to a reference atlas can continuously refine the coordinate system and associated variance. We apply this approach to the adult murine brainstem and achieve a precise alignment of projections in cytoarchitecturally ill-defined regions across brains from different animals.

Técnicas de marketing en publicidades de alimentos y bebidas en canales infantiles de Argentina: diferencias según calidad nutricional / Marketing Techniques in Food and Beverage Advertising on Children's Channels in Argentina: Differences according to Nutritional Quality

INTRODUCCIÓN: Las publicidades utilizan un amplio espectro de técnicas visuales, auditivas y emocionales para persuadir a los niños o padres, empleando diferentes estrategias según la calidad nutricional de los alimentos y bebidas. OBJETIVOS: Describir las técnicas de marketing utilizadas en las publicidades de alimentos y bebidas durante la programación televisiva infantil y su relación con la calidad nutricional de los alimentos y bebidas. MÉTODOS: Se realizó un estudio descriptivo y transversal. Las técnicas de marketing se categorizaron según el modelo propuesto por Hebden, que considera atractivo emocional, características del producto, elementos visuales y elementos de sonido y audio. Se analizaron 100 publicidades; una cuarta parte de los alimentos y bebidas se categorizaron como saludables según el sistema de perfiles de nutrientes de Food Standards Agency (FSA). RESULTADOS: Las técnicas de marketing más utilizadas fueron la diversión/felicidad (83% de los anuncios), fantasía e imaginación (59%), palatabilidad (54%), dibujos o personajes animados (55%), música/jingles (97%) y mensajes dirigidos al público infantil (83%). CONCLUSIONES: Se observaron diferencias entre las técnicas utilizadas según la calidad nutricional de los alimentos y bebidas.

INTRODUCTION: Advertising uses a broad spectrum of visual, auditory and emotional techniques to persuade children or parents, with different strategies according to the nutritional quality of food and beverages. OBJECTIVES: To describe the marketing techniques used in food and beverage advertising during children's TV programming and their relation with the nutritional quality of food and beverages. METHODS: A descriptive and cross-sectional study was carried out. Marketing techniques were classified according to Hebden by emotional appeal, product characteristics, visual elements, and sound and audio elements. A total of 100 advertisements were analyzed, 25% of the food and beverages were categorized as healthy according to the nutrient profiling system of Food Standards Agency (FSA). RESULTS: The most used marketing techniques were fun/happiness (83%), fantasy and imagination (59%), palatability (54%), cartoon or animated characters (55%), music/jingles (97%) and messages aimed at children (83%). CONCLUSIONS: Differences were observed between the techniques according to the nutritional quality of food and beverages.

Alimentos y bebidas publicitados en canales infantiles de Argentina: frecuencia, duración y calidad nutricional / Food and beverage advertising on children's TV channels in Argentina: Frequency, duration, and nutritional quality

El marketing de alimentos y bebidas ha sido identificado como uno de los determinantes del consumo de alimentos y bebidas poco saludables en la población infantil. Objetivo. Conocer la frecuencia y duración de publicidades de alimentos y bebidas en programación televisiva infantil y la calidad nutricional de los alimentos y bebidas publicitados. Métodos. Estudio descriptivo transversal. Se realizaron grabaciones en dos períodos, durante la semana y el fin de semana, de canales de cable infantiles y de la programación infantil de los canales de aire. Se registró el tipo, la cantidad y el tiempo de las publicidades emitidas. Se analizó la calidad nutricional de los alimentos y bebidas publicitados. Resultados. Se analizaron 402,3 horas de programación infantil. Se registraron 3711 avisos publicitarios. El 20,9% de las publicidades correspondieron a alimentos y bebidas, en promedio 1,9 ± 1,0 avisos por hora, equivalente a 0,68 ± 0,36 min/hora. Los lácteos, golosinas y productos de las cadenas de comidas rápidas fueron los alimentos con mayor presencia. Solo una tercera parte de los alimentos y bebidas publicitados (35,8%) fueron categorizados como saludables según el sistema de perfiles nutricionales. De acuerdo con el sistema de perfilado del semáforo nutricional, la mitad eran altos en azúcares; una cuarta parte, altos en grasas saturadas y, aproximadamente, 15% eran altos en sodio o grasas. Conclusión. La publicidad de alimentos y bebidas ocupó una quinta parte del tiempo de publicidad televisiva. Los grupos de alimentos más publicitados fueron los lácteos seguidos por dulces y golosinas, productos de las cadenas de comidas rápidas y bebidas. Dos terceras partes de los alimentos y bebidas publicitados se consideraron poco saludables.

Food and beverage marketing has been identified as one of the determinants of unhealthy food and beverage consumption in the child population. Objective. To determine the frequency and duration of food and beverage advertising in children's programming and the nutritional quality of advertised food and beverages. Methods. Descriptive, cross-sectional study. Children's cable and broadcast channel programming was recorded in two periods: over the week and on the weekend. The type, quantity, and duration of commercials were recorded. The nutritional quality of advertised food and beverages was analyzed. Results. A total of 402.3 hours of children's programming were recorded. In total, 3711 commercials were identified. Among these, 20.9% corresponded to food and beverages, i.e., an average of 1.9 ± 1.0 commercials per hour or equivalent to 0.68 ± 0.36 min/hour. Dairy products, candies, and fast-food meals were the most advertised food products. Only a third of advertised food and beverages (35.8%) were categorized as healthy as per the nutrient profiling system. Based on the traffic light labeling system, 50% of advertised food and beverages were high in sugar, 25% were high in saturated fat, and approximately 15% were high in sodium or fat. Conclusion. Food and beverage advertising accounted for 20% of television advertising time. The most advertised products were dairy products, followed by candies and sweet snacks, fast-food meals, and beverages. Two-thirds of advertised food and beverages were considered unhealthy.

Food and beverage advertising on children's TV channels in Argentina: Frequency, duration, and nutritional quality. / Alimentos y bebidas publicitados en canales infantiles de Argentina: frecuencia, duración y calidad nutricional.

Food and beverage marketing has been identified as one of the determinants of unhealthy food and beverage consumption in the child population. OBJECTIVE: To determine the frequency and duration of food and beverage advertising in children's programming and the nutritional quality of advertised food and beverages. METHODS: Descriptive, cross-sectional study. Children's cable and broadcast channel programming was recorded in two periods: over the week and on the weekend. The type, quantity, and duration of commercials were recorded. The nutritional quality of advertised food and beverages was analyzed. RESULTS: A total of 402.3 hours of children's programming were recorded. In total, 3711 commercials were identified. Among these, 20.9% corresponded to food and beverages, i.e., an average of 1.9 ± 1.0 commercials per hour or equivalent to 0.68 ± 0.36 min/hour. Dairy products, candies, and fast-food meals were the most advertised food products. Only a third of advertised food and beverages (35.8%) were categorized as healthy as per the nutrient profiling system. Based on the traffic light labeling system, 50% of advertised food and beverages were high in sugar, 25% were high in saturated fat, and approximately 15% were high in sodium or fat. CONCLUSION: Food and beverage advertising accounted for 20% of television advertising time. The most advertised products were dairy products, followed by candies and sweet snacks, fast-food meals, and beverages. Two-thirds of advertised food and beverages were considered unhealthy.

El marketing de alimentos y bebidas ha sido identificado como uno de los determinantes del consumo de alimentos y bebidas poco saludables en la población infantil. Objetivo. Conocer la frecuencia y duración de publicidades de alimentos y bebidas en programación televisiva infantil y la calidad nutricional de los alimentos y bebidas publicitados. Métodos. Estudio descriptivo transversal. Se realizaron grabaciones en dos períodos, durante la semana y el fin de semana, de canales de cable infantiles y de la programación infantil de los canales de aire. Se registró el tipo, la cantidad y el tiempo de las publicidades emitidas. Se analizó la calidad nutricional de los alimentos y bebidas publicitados. Resultados. Se analizaron 402,3 horas de programación infantil. Se registraron 3711avisos publicitarios. El 20,9% de las publicidades correspondieron a alimentos y bebidas, en promedio 1,9 ± 1,0 avisos por hora, equivalente a 0,68 ± 0,36 min/hora. Los lácteos, golosinas y productos de las cadenas de comidas rápidas fueron los alimentos con mayor presencia. Solo una tercera parte de los alimentos y bebidas publicitados (35,8%) fueron categorizados como saludables según el sistema de perfiles nutricionales. De acuerdo con el sistema de perfilado del semáforo nutricional, la mitad eran altos en azúcares; una cuarta parte, altos en grasas saturadas y, aproximadamente, 15% eran altos en sodio o grasas. Conclusión. La publicidad de alimentos y bebidas ocupó una quinta parte del tiempo de publicidad televisiva. Los grupos de alimentos más publicitados fueron los lácteos seguidos por dulces y golosinas, productos de las cadenas de comidas rápidas y bebidas. Dos terceras partes de los alimentos y bebidas publicitados se consideraron poco saludables.

Mathematical Model of Evolution of Brain Parcellation.

We study the distribution of brain and cortical area sizes [parcellation units (PUs)] obtained for three species: mouse, macaque, and human. We find that the distribution of PU sizes is close to lognormal. We propose the mathematical model of evolution of brain parcellation based on iterative fragmentation and specialization. In this model, each existing PU has a probability to be split that depends on PU size only. This model suggests that the same evolutionary process may have led to brain parcellation in these three species. Within our model, region-to-region (macro) connectivity is given by the outer product form. We show that most experimental data on non-zero macaque cortex macroscopic-level connections can be explained by the outer product power-law form suggested by our model (62% for area V1). We propose a multiplicative Hebbian learning rule for the macroconnectome that could yield the correct scaling of connection strengths between areas. We thus propose an evolutionary model that may have contributed to both brain parcellation and mesoscopic level connectivity in mammals.

First-Ever Stroke and Transient Ischemic Attack Incidence and 30-Day Case-Fatality Rates in a Population-Based Study in Argentina.

BACKGROUND AND PURPOSE: Epidemiological data about stroke are scarce in low- and middle-income Latin-American countries. We investigated annual incidence of first-ever stroke and transient ischemic attack (TIA) and 30-day case-fatality rates in a population-based setting in Tandil, Argentina. METHODS: We prospectively identified all first-ever stroke and TIA cases from overlapping sources between January 5, 2013, and April 30, 2015, in Tandil, Argentina. We calculated crude and standardized incidence rates. We estimated 30-day case-fatality rates. RESULTS: We identified 334 first-ever strokes and 108 TIAs. Age-standardized incidence rate per 100 000 for Segi's World population was 76.5 (95% confidence interval [CI], 67.8-85.9) for first-ever stroke and 25.1 (95% CI, 20.2-30.7) for first-ever TIA, 56.1 (95% CI, 48.8-64.2) for ischemic stroke, 13.5 (95% CI, 9.9-17.9) for intracerebral hemorrhage, and 4.9 (95% CI, 2.7-8.1) for subarachnoid hemorrhage. Stroke incidence was slightly higher for men (87.8; 95% CI, 74.6-102.6) than for women (73.2; 95% CI, 61.7-86.1) when standardized for the Argentinean population. Thirty-day case-fatality rate was 14.7% (95% CI, 10.8-19.5) for ischemic stroke, 24.1% (95% CI, 14.2-36.6) for intracerebral hemorrhage, and 1.9% (95% CI, 0.4-5.8) for TIA. CONCLUSIONS: This study provides the first prospective population-based stroke and TIA incidence and case-fatality estimate in Argentina. First-ever stroke incidence was lower than that reported in previous Latin-American studies, but first-ever TIA incidence was higher. Thirty-day case-fatality rates were similar to those of other population-based Latin-American studies.

Desigualdades en la distribución de factores de riesgo en enfermedades cardiovasculares en la Argentina. Un estudio a partir de la Encuesta Nacional de Factores de Riesgo (ENFR) 2005, 2009 y 2013 / Inequalities in the Distribution of Cardiovascular Disease Risk Factors in Argentina. A Study from the 2005, 2009 and 2013 National Risk Factor Survey (NRFS)

Introducción: Las desigualdades en salud cardiovascular se han documentado en la literatura tanto en países desarrollados como no desarrollados y existe una asociación inversa entre la incidencia y mortalidad por causa específica de enfermedades cardiovasculares y los niveles de ingreso, educación y empleo. Objetivo: Identificar la existencia de desigualdades en la prevalencia de factores de riesgo por nivel socioeconómico en la Argentina. Material y métodos: Análisis de los datos de la Encuesta Nacional de Factores de Riesgo (ENFR) de 2005, 2009 y 2013. Se estudió la prevalencia de obesidad, tabaquismo, hipertensión arterial y colesterol. Se estimaron las brechas para cada factor de riesgo en relación con el nivel socioeconómico (medido con educación, ingreso y cobertura de salud). La asociación independiente entre nivel socioeconómico y factores de riesgo se evaluó con modelos de regresión logística. Resultados: El nivel educativo se asoció inversamente con la prevalencia de obesidad (p < 0,01), hipercolesterolemia (p < 0,01), hipertensión arterial (p < 0,01) y tabaquismo (p < 0,05) y el efecto varió por grupos de edad y sexo. El nivel de ingreso se asoció significativamente y de manera inversa con la prevalencia de hipertensión (p < 0,01). La evolución temporal de las desigualdades indica que no hubo atenuación de estas entre las encuestas y, por el contrario, muestra un incremento en las brechas de tabaquismo. Conclusiones: Se registraron profundas desigualdades en la distribución de factores de riesgo cardiovascular por niveles educativos. Los grupos con elevada carga de factores de riesgo constituyen poblaciones vulnerables sobre las cuales deberían orientarse políticas preventivas.