COVID-19: Reestructuración de emergencia e impacto de la pandemia en una Sección de Cirugía Mininvasiva Guiada por Imágenes / Emergency restructuring and impact of the pandemic in an Image-Guided Minimally Invasive Surgery Section

Antecedentes: La enfermedad por coronavirus-19 (COVID-19) ha forzado cambios en todas las facetas de los sistemas de salud. En este artículo se describen las modificaciones realizadas en la Sección de Cirugía Miniinvasiva Guiada por Imágenes (CIGIM) del Hospital Italiano de Buenos Aires, para promover la seguridad y el bienestar del personal manteniendo la capacidad de respuesta a la demanda asistencial y académica. Material y métodos: Las medidas incluyeron la reorganización del personal, el manejo de los procedimientos electivos y de urgencia, las consultas ambulatorias, así como la actividad docente y de investigación. También se analizó comparativamente la variación interanual (2019-2020) de los pacientes atendidos (procedimientos percutáneos y consultas ambulatorias) entre el 20 de marzo y el 10 de mayo de cada año. Resultados: La Sección CIGIM fue reorganizada en rotaciones semanales de 3 actividades, con distanciamiento estricto entre sus miembros, y hasta el momento ninguno resultó afectado. Los pacientes operados y las consultas realizadas durante el período estudiado 2019 vs. 2020 disminuyeron significativamente: 136 vs. 57 operados y 102 vs. 39 consultas; p < 0,0001. Las plataformas virtuales se utilizaron con éxito para mantener la actividad de pregrado, incluyendo cursadas de alumnos de grado de Medicina de dos universidades, el programa de residencia de Cirugía General y reuniones científicas; en dicho período se produjeron 3 trabajos científicos para publicación. Conclusiones: La disminución de la demanda asistencial, la reorganización de los grupos de trabajo y las plataformas virtuales pueden resultar estrategias y herramientas valiosas para afrontar la pandemia por COVID-19.

Background: Coronavirus-19 disease (COVID-19) has forced changes in all facets of health systems. This article describes the modifications made in the Image-Guided Minimally Invasive Surgery Section (CIGIM) of the Hospital Italiano de Buenos Aires, to promote the safety and well being of personnel while maintaining the ability to respond to academic and healthcare demand. Material and methods: Measures included reorganization of staff, management of elective and emergency procedures, outpatient consultations, as well as teaching and research activity. The inter-annual variation (2019-2020) of the patients attended (percutaneous procedures and outpatient consultations) between March 20 and May 10 of each year was also analyzed comparatively. Results: The CIGIM Section was reorganized into weekly rotations of 3 activities, with strict distancing among its members, and so far none have been affected. The operated patients and the consultations made during the analyzed period of 2019 vs. 2020 decreased significantly: 136 vs. 57 operated and 102 vs. 39 consultations; p <0.0001. Virtual platforms were successfully used to maintain undergraduate activity, including courses taken by medical students from two universities, the General Surgery residency program and scientific meetings; In this period, 3 scientific papers were written for publication. Conclusions: Dealing with healthcare demand, reorganizing working groups and virtual platforms can be valuable strategies and tools to confront the COVID-19 pandemic.

Trypanosoma cruzi surface mucin TcMuc-e2 expressed on higher eukaryotic cells induces human T cell anergy, which is reversible.

Chagas' disease is a chronic, debilitating, multisystemic disorder that affects millions of people in Latin America. The protozoan parasite Trypanosoma cruzi, the etiological agent of Chagas' disease, has a large number of O-glycosylated Thr/Ser/Pro-rich mucin molecules on its surface (TcMuc). These mucins are the main acceptors of sialic acid and have been suggested to play a role on various host-parasite interactions, such as adhesion to macrophages, protection from complement lysis, and immunomodulation of the immune response mounted by the host. To observe the immunologic effect obtained by the heterologous expression of a TcMuc gene in higher eukaryotic cells exposed to xenogeneic lymphocytes, we developed a strategy based on the transfection of a known T. cruzi mucin gene (TcMuc-e2) into Vero cells. In contrast to the brisk proliferation and activation of human lymphocytes observed at 3, 4, and 5 days induced by normal Vero cells, neither proliferation nor significant activation of human lymphocytes was observed with TcMuc-e2-transfected Vero cells. This TcMuc-e2 mucin-induced suppression of T cell response can be reversed by the addition of exogenous IL-2. In addition it was demonstrated that the immunosuppressive reaction was not related to the induction of an important degree of apoptosis in human lymphocytes. Posttranslational modification are required for the inhibitory effect that TcMuc-e2 exerts when transfected to Vero cells. O-glycosylation and sialylation are required to obtain the immunomodulatory effect as assessed by O-sialoglycoprotease and neuraminidase treatments. These results are consistent with other studies showing that surface glycoconjugates from T. cruzi and mammalian cells can induce an inhibition of the immune response.