[Geographic variability, health inequities and lethality due to COVID-19 in Bariloche, Río Negro, 2020-2021]. / Variabilidad geográfica, inequidades en salud y letalidad por COVID-19 en Bariloche, Río Negro, 2020-2021.

INTRODUCTION: The objective of this study was to analyze the geographic variability and the relationship between social determinants of health and COVID-19 lethality in Bariloche. METHODS: A database from the National Epidemiological Surveillance System was used to analyze COVID-19 positive cases from January 2020 to December 2021. The data were geocoded and incorporated into a geographic information system (GIS). A three-step analytical framework was applied to measure health inequity, using socioeconomic indicators and access to services. A multivariate analysis was conducted to predict fatality. RESULTS: A total of 25 020 COVID-19 cases were diagnosed in Bariloche during the study period. The fatality rate was 2.1%. Significant variability in socioeconomic indicators was observed among different territorial delegations of the city. DISCUSSION: The results showed health inequities and an association between social determinants and COVID-19 lethality in Bariloche. Individuals living in areas with higher socioeconomic vulnerability had a higher risk of mortality. These findings highlight the importance of addressing health inequities in a pandemic response.

Introducción: El objetivo de este estudio fue examinar cómo la variabilidad geográfica y los determinantes sociales de la salud influyen en la tasa de letalidad por COVID-19 en Bariloche. Métodos: Se utilizó una base de datos del Sistema Nacional de Vigilancia Epidemiológica para analizar los casos positivos de COVID-19 desde enero de 2020 hasta diciembre de 2021. Los datos se geo-codificaron y se incorporaron en un sistema de información geográfica (SIG). Se aplicó un marco de análisis en tres pasos para medir la inequidad en salud, utilizando indicadores socioeconómicos y de acceso a servicios. Se realizó un análisis multivariado para predecir la letalidad. Resultados: Se diagnosticaron un total de 25 020 casos de COVID-19 en Bariloche durante el período de estudio. La letalidad fue del 2.1%. Se observó una variabilidad significativa en indicadores socioeconómicos entre las diferentes delegaciones territoriales de la ciudad. Discusión: Los resultados mostraron inequidades en salud y una asociación entre determinantes sociales y letalidad por COVID-19 en Bariloche. Las personas que vivían en áreas con mayor vulnerabilidad socioeconómica presentaron un mayor riesgo de mortalidad. Estos hallazgos resaltan la importancia de abordar las inequidades en salud en la respuesta a una pandemia.

Viral reactivations and co-infections in COVID-19 patients: a systematic review.

BACKGROUND: Viral reactivations and co-infections have been reported among COVID-19 patients. However, studies on the clinical outcomes of different viral reactivations and co-infections are currently in limit. Thus, the primary purpose of this review is to perform an overarching investigation on the cases of latent virus reactivation and co-infection in COVID-19 patients to build collective evidence contributing to improving patient health. The aim of the study was to conduct a literature review to compare the patient characteristics and outcomes of reactivations and co-infections of different viruses. METHODS: Our population of interest included confirmed COVID-19 patients who were diagnosed with a viral infection either concurrently or following their COVID-19 diagnosis. We extracted the relevant literature through a systematic search using the key terms in the online databases including the EMBASE, MEDLINE, Latin American Caribbean Health Sciences Literature (LILACS), from inception onwards up to June 2022. The authors independently extracted data from eligible studies and assessed the risk of bias using the Consensus-based Clinical Case Reporting (CARE) guidelines and the Newcastle-Ottawa Scale (NOS). Main patient characteristics, frequency of each manifestation, and diagnostic criteria used in studies were summarized in tables. RESULTS: In total, 53 articles were included in this review. We identified 40 reactivation studies, 8 coinfection studies, and 5 studies where concomitant infection in COVID-19 patients was not distinguished as either reactivation or coinfection. Data were extracted for 12 viruses including IAV, IBV, EBV, CMV, VZV, HHV-1, HHV-2, HHV-6, HHV-7, HHV-8, HBV, and Parvovirus B19. EBV, HHV-1, and CMV were most frequently observed within the reactivation cohort, whereas IAV and EBV within the coinfection cohort. In both reactivation and coinfection groups, patients reported cardiovascular disease, diabetes, and immunosuppression as comorbidities, acute kidney injury as complication, and lymphopenia and elevated D-dimer and CRP levels from blood tests. Common pharmaceutical interventions in two groups included steroids and antivirals. CONCLUSION: Overall, these findings expand our knowledge on the characteristics of COVID-19 patients with viral reactivations and co-infections. Our experience with current review indicates a need for further investigations on virus reactivation and coinfection among COVID-19 patients.

Long-term effects of different exercise training modes on cytokines and adipokines in individuals with overweight/obesity and cardiometabolic diseases: A systematic review, meta-analysis, and meta-regression of randomized controlled trials.

The present study aimed to investigate the evidence on the effects of different long-term training interventions (aerobic [AeT], resistance [RT], and combined [COMB]) and spontaneous physical activity (PA) in modifying cytokines and adipokines in individuals with overweight or obesity with or without cardiometabolic diseases while considering potential confounders. Although exercise interventions have become a potentially effective tool for preventing and treating metabolic diseases, the evidence provided by previous systematic reviews is inconclusive since several potential confounders have yet to be addressed. Therefore, we conducted a systematic literature search in Medline, Cochrane, and Embase databases from January 2000 to July 2022 and performed a meta-analysis. Inclusion criteria retrieved 106 full texts comprising 8,642 individuals with a range BMI of 25.1-43.8 kg m-2 . We found that independently of the training mode, exercise had a beneficial effect on diminishing Adiponectin, C-reactive protein (CRP), IL-6, IL-18, IL-20, Leptin, sICAM, and TNF-α levels circulating levels. Furthermore, by subsequent analysis, we detected differential effects of AeT, RT, and COMB, with sex, age, body composition, and trial length acting as moderators. The comparison of training modes revealed a difference favoring COMB over AeT for regulating the increase in CRP with no differences in the remaining biomarkers. Meta-regression analysis revealed an effect of change in maximal oxygen uptake (VO2max ) on CRP, IL-6, and TNF-α, while IL-10 was influenced by the change in body fat. The results suggest that all interventions, except PA, are effective in lessening this population's inflammatory status, provided that exercise results in an increase of VO2max .

The BIGG-REC database makes available all WHO/PAHO evidence informed recommendations.

OBJECTIVES: To build and maintain a living database of the Pan American Health Organization/World Health Organization (PAHO/WHO) recommendations developed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). STUDY DESIGN AND SETTING: Guidelines are identified from WHO and PAHO databases. We periodically extract recommendations, according to the health and well-being targets of sustainable development goal 3 (SDG-3). RESULTS: As of March 2022, the International database of GRADE guidelines (https://bigg-rec.bvsalud.org/en) database hosted 2,682 recommendations contained in 285 WHO/PAHO guidelines. Recommendations were classified as follows: communicable diseases (1,581), children's health (1,182), universal health (1,171), sexual and reproductive health (910), noncommunicable diseases (677), maternal health (654), COVID-19 (224), use of psychoactive substances (99), tobacco (14) and road and traffic accidents (16). International database of GRADE guidelines allows searching by SDG-3, condition or disease, type of intervention, institution, year of publication, and age. CONCLUSION: Recommendation maps provide an important resource for health professionals, organizations and member states that use evidence-informed guidance to make better decisions, providing a source for the adoption or adaptation of recommendations to meet their needs. This one-stop shop database of evidence-informed recommendations built with intuitive functionalities undoubtedly represents a long-needed tool for decision-makers, guideline developers, and the public at large.

[Evidence synthesis for COVID-19 interventions: update reports from Argentina's National Commission for Health Technology AssessmentSíntese de evidências para intervenções em COVID-19: relatórios de atualização da Comissão Nacional de Avaliação de Tecnologias em Saúde da Argentina]. / Síntesis de evidencia para intervenciones en COVID-19: informes de actualización de la Comisión Nacional de Evaluación de Tecnologías de Salud de Argentina.

This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

Este relatório tem como objetivo apresentar o trabalho realizado sobre o delineamento, publicação e impacto das atualizações para intervenções em COVID-19 baseadas em evidências, que visam fornecer sínteses de evidências atualizadas provenientes de revisões sistemáticas vivas sobre intervenções terapêuticas para apoiar a tomada de decisões. Para isso, foi criado um grupo de trabalho específico no âmbito da Comissão Nacional de Avaliação de Tecnologias de Saúde (CONETEC, na sigla em espanhol), do Ministério da Saúde da Argentina, em parceria com a Organização Pan-Americana da Saúde (OPAS). Foi desenhada uma metodologia para a elaboração e publicação de documentos de avaliação destinados a apoiar a tomada de decisões. Esses relatórios de atualização se basearam na exploração de três domínios: efeitos na saúde, viabilidade da implementação e recomendações baseadas em evidências. As conclusões foram adaptadas a uma escala semafórica de acordo com o equilíbrio entre os benefícios e os aspectos negativos para os diferentes cenários clínicos, de forma a melhorar a sua interpretação e aplicação. Durante o ano de 2021, foram publicados 16 relatórios de síntese de evidências (13 originais e 3 atualizações completas), que receberam um número significativo de consultas no site da CONETEC e da Base Regional de Informes de Avaliação de Tecnologias em Saúde das Américas (BRISA). Assim, tornou-se visível a necessidade de contar com resumos de evidências robustos, atualizados e confiáveis adaptados ao contexto de aplicação no sistema de saúde do país. A atualização constante das informações, sua divulgação adequada e a manutenção do rigor na elaboração dos relatórios também apresentam desafios.

Síntesis de evidencia para intervenciones en COVID-19: informes de actualización de la Comisión Nacional de Evaluación de Tecnologías de Salud de Argentina

[RESUMEN]. Este informe tiene por objetivo exponer el trabajo realizado sobre el diseño, la publicación y el impacto de las actualizaciones para intervenciones en COVID-19 basadas en la evidencia, para brindar síntesis de evi- dencia actualizadas a partir de revisiones sistemáticas vivas sobre intervenciones terapéuticas para dar soporte en la toma de decisiones. Para ello, se generó un grupo específico de trabajo en el ámbito de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC) en el Ministerio de Salud de Argentina en colaboración con la Organización Panamericana de la Salud (OPS). Se diseñó una metodología para ela- borar y publicar documentos de evaluación orientados a dar apoyo en la toma de decisiones. Estos informes de actualización se respaldaron en la exploración de tres dominios: los efectos en la salud, la factibilidad de la implementación y las recomendaciones basadas en evidencia. Las conclusiones se adaptaron en un esquema semaforizado según el balance entre los beneficios y los aspectos negativos para los distintos esce- narios clínicos, a fin de mejorar su interpretación y aplicación. Durante el año 2021 se publicaron 16 informes de síntesis de evidencia (13 originales y 3 actualizaciones completas) que recibieron un destacado número consultas desde la página web de CONETEC y la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Así se hizo visible la necesidad de disponer de resúmenes de evidencia robustos, actualizados y confiables con adaptación al contexto de aplicación en el sistema sanitario del país. El desafío se presenta, además, en la actualización constante de la información, la diseminación apropiada y el sostenimiento en la rigurosidad en el desarrollo de los informes.

[ABSTRACT]. This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recom- mendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

[RESUMO]. Este relatório tem como objetivo apresentar o trabalho realizado sobre o delineamento, publicação e impacto das atualizações para intervenções em COVID-19 baseadas em evidências, que visam fornecer sínteses de evidências atualizadas provenientes de revisões sistemáticas vivas sobre intervenções terapêuticas para apoiar a tomada de decisões. Para isso, foi criado um grupo de trabalho específico no âmbito da Comis- são Nacional de Avaliação de Tecnologias de Saúde (CONETEC, na sigla em espanhol), do Ministério da Saúde da Argentina, em parceria com a Organização Pan-Americana da Saúde (OPAS). Foi desenhada uma metodologia para a elaboração e publicação de documentos de avaliação destinados a apoiar a tomada de decisões. Esses relatórios de atualização se basearam na exploração de três domínios: efeitos na saúde, viabilidade da implementação e recomendações baseadas em evidências. As conclusões foram adaptadas a uma escala semafórica de acordo com o equilíbrio entre os benefícios e os aspectos negativos para os dife- rentes cenários clínicos, de forma a melhorar a sua interpretação e aplicação. Durante o ano de 2021, foram publicados 16 relatórios de síntese de evidências (13 originais e 3 atualizações completas), que receberam um número significativo de consultas no site da CONETEC e da Base Regional de Informes de Avaliação de Tecnologias em Saúde das Américas (BRISA). Assim, tornou-se visível a necessidade de contar com resumos de evidências robustos, atualizados e confiáveis adaptados ao contexto de aplicação no sistema de saúde do país. A atualização constante das informações, sua divulgação adequada e a manutenção do rigor na elaboração dos relatórios também apresentam desafios.

Síndrome inflamatorio multisistémico asociado a COVID-19 en pediatría: serie de casos en servicios públicos de salud de Neuquén / Multisystem inflammatory syndrome associated with COVID-19 in children: case series in Neuquén public health services

INTRODUCCIÓN: Durante la pandemia por SARS-CoV-2 se reportaron casos de un síndrome de inflamación multisistémica similar a la enfermedad de Kawasaki con antecedente de infección reciente o contacto con casos de COVID-19, generando una relación temporal con dicha enfermedad (SIM-C). El objetivo de este trabajo fue caracterizar los aspectos clínicos y epidemiológicos de los casos de SIM-C en menores de 18 años. MÉTODOS: Se realizó un estudio transversal, observacional y descriptivo de casos de SIM-C en menores de 18 años asistidos entre marzo de 2020 y junio de 2022 en el sistema público de la provincia de Neuquén. RESULTADOS: Serie de casos: Se incluyó a 9 pacientes con SIM-C: 55,5% de sexo femenino, con una media de edad de 6,1 años. El 77,7% de los casos de COVID-19 fueron confirmados por nexo epidemiológico. Todos los pacientes presentaron fiebre previa a la internación, el 88,8% tuvo manifestaciones mucocutáneas y compromiso abdominal. Otras manifestaciones frecuentes fueron compromiso ocular y edema de manos. El 33,3% de los pacientes requirieron internación en unidades de cuidados intensivos pediátricos. Solo 1 necesitó asistencia respiratoria mecánica por 48 horas por shock. Todos los pacientes fueron tratados con inmunoglobulina intravenosa (IGIV) 2 g/kg, y 3 pacientes recibieron corticoterapia. No hubo fallecimientos ni complicaciones en el seguimiento. DISCUSIÓN: Aunque el pronóstico es favorable, se sugiere realizar estudios que monitoreen los efectos a largo plazo de SIM-C.

Síntesis de evidencia para intervenciones en COVID-19: informes de actualización de la Comisión Nacional de Evaluación de Tecnologías de Salud de Argentina / Evidence synthesis for COVID-19 interventions: update reports from Argentina's National Commission for Health Technology Assessment / Síntese de evidências para intervenções em COVID-19: relatórios de atualização da Comissão Nacional de Avaliação de Tecnologias em Saúde da Argentina

RESUMEN Este informe tiene por objetivo exponer el trabajo realizado sobre el diseño, la publicación y el impacto de las actualizaciones para intervenciones en COVID-19 basadas en la evidencia, para brindar síntesis de evidencia actualizadas a partir de revisiones sistemáticas vivas sobre intervenciones terapéuticas para dar soporte en la toma de decisiones. Para ello, se generó un grupo específico de trabajo en el ámbito de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC) en el Ministerio de Salud de Argentina en colaboración con la Organización Panamericana de la Salud (OPS). Se diseñó una metodología para elaborar y publicar documentos de evaluación orientados a dar apoyo en la toma de decisiones. Estos informes de actualización se respaldaron en la exploración de tres dominios: los efectos en la salud, la factibilidad de la implementación y las recomendaciones basadas en evidencia. Las conclusiones se adaptaron en un esquema semaforizado según el balance entre los beneficios y los aspectos negativos para los distintos escenarios clínicos, a fin de mejorar su interpretación y aplicación. Durante el año 2021 se publicaron 16 informes de síntesis de evidencia (13 originales y 3 actualizaciones completas) que recibieron un destacado número consultas desde la página web de CONETEC y la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Así se hizo visible la necesidad de disponer de resúmenes de evidencia robustos, actualizados y confiables con adaptación al contexto de aplicación en el sistema sanitario del país. El desafío se presenta, además, en la actualización constante de la información, la diseminación apropiada y el sostenimiento en la rigurosidad en el desarrollo de los informes.

ABSTRACT This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

RESUMO Este relatório tem como objetivo apresentar o trabalho realizado sobre o delineamento, publicação e impacto das atualizações para intervenções em COVID-19 baseadas em evidências, que visam fornecer sínteses de evidências atualizadas provenientes de revisões sistemáticas vivas sobre intervenções terapêuticas para apoiar a tomada de decisões. Para isso, foi criado um grupo de trabalho específico no âmbito da Comissão Nacional de Avaliação de Tecnologias de Saúde (CONETEC, na sigla em espanhol), do Ministério da Saúde da Argentina, em parceria com a Organização Pan-Americana da Saúde (OPAS). Foi desenhada uma metodologia para a elaboração e publicação de documentos de avaliação destinados a apoiar a tomada de decisões. Esses relatórios de atualização se basearam na exploração de três domínios: efeitos na saúde, viabilidade da implementação e recomendações baseadas em evidências. As conclusões foram adaptadas a uma escala semafórica de acordo com o equilíbrio entre os benefícios e os aspectos negativos para os diferentes cenários clínicos, de forma a melhorar a sua interpretação e aplicação. Durante o ano de 2021, foram publicados 16 relatórios de síntese de evidências (13 originais e 3 atualizações completas), que receberam um número significativo de consultas no site da CONETEC e da Base Regional de Informes de Avaliação de Tecnologias em Saúde das Américas (BRISA). Assim, tornou-se visível a necessidade de contar com resumos de evidências robustos, atualizados e confiáveis adaptados ao contexto de aplicação no sistema de saúde do país. A atualização constante das informações, sua divulgação adequada e a manutenção do rigor na elaboração dos relatórios também apresentam desafios.

Factores pronósticos de síndrome cardio-pulmonar y muerte por hantavirus Andes Sur: estudio de cohorte en San Carlos de Bariloche y su zona de influencia sanitaria / Prognostic factors for cardio-pulmonary syndrome and death by hantavirus Andes Sur: cohort study in San Carlos de Bariloche and health influence área

Resumen Las infecciones por hantavirus, ocurren a través de la inhalación de aerosoles provenientes de excretas de roedores infectados. Estos virus causan síndrome cardiopulmonar en el caso de la variante Andes Sur, con una mortalidad que puede alcanzar el 50%. Se presenta como casos esporádicos o en pequeños conglomerados, en los que predomina el contagio interhumano. En este estudio observacional de tipo cohorte histórica, en personas infectadas con hantavirus Andes Sur durante los años 2009 a 2019 que fueron asistidas en el subsector público de salud de San Carlos de Bariloche(Argentina), se buscó identificar factores que pudieran predecir mala evolución (síndrome cardiopulmonar y muerte). Para ello se caracterizó el riesgo para cada una de las variables y, para obtener información clave sobre las relaciones entre las mismas, se aplicó además un análisis de correspondencias múltiples. Durante el período de estudio, 38 personas fueron incluidas. La edad media fue de 35 años. Se sospechó contagio de persona a persona en 10/38 (26.8%) casos. El 21.1% (8/28) tuvo al momento del diagnóstico un síndrome pulmonar por hantavirus. Mientras que, 55.3% (21/38) lo desarrolló durante su evolución y 44.7% (17/38) de los infectados fallecieron durante la internación. La edad mayor a 15 años y la plaquetopenia, se asociaron con un mayor riesgo de progresión clínica, mientras que las formas de leves o las personas asintomáticas, el contagio persona a persona o durante un brote epidemiológico, se asociaron con un menor riesgo de muerte.

Abstract Hantavirus infections occur through the inhalation of aerosols from the excreta of infected rodents. These viruses cause a cardiopulmonary syn drome in the case of the Andes Sur variant, with a mortality that can reach 50%. It occurs in sporadic cases or in small clusters, in which interhuman contagion predominates. In this historical cohort-type observational study, in people infected with Andes Sur hantavirus during the years 2009 to 2019 who was assisted in the public health subsector of San Carlos de Bariloche (Argentina), it was sought to identify factors that could predict poor evolution (cardiopulmonary syndrome and death). For this, the risk for each of the variables was characterized and, to obtain key information about the relationships between them, a multiple correspondence analysis was also applied. During the study period, 38 people were included. The mean age was 35 years. Person-to-person contagion was suspected in 10/38 (26.8%) cases. 21.1% (8/28) presented a hantavirus pulmonary syndrome at the time of diagnosis, while 55.3% (21/38) developed it during their evolution, and 44.7% (17/38) of those infected died during hospitalization. Age over 15 years and thrombocytopenia were associated with a higher risk of clinical progression, while mild forms or asymptomatic people, person-to-person transmission, or during an epidemiological outbreak, were associated with a lower risk of death.

[Prognostic factors for cardio-pulmonary syndrome and death by hantavirus Andes Sur: cohort study in San Carlos de Bariloche and health influence area]. / Factores pronósticos de síndrome cardiopulmonar y muerte por hantavirus Andes Sur: Estudio de cohorte en San Carlos de Bariloche y su zona de influencia sanitaria.

Hantavirus infections occur through the inhalation of aerosols from the excreta of infected rodents. These viruses cause a cardiopulmonary syndrome in the case of the Andes Sur variant, with a mortality that can reach 50%. It occurs in sporadic cases or in small clusters, in which interhuman contagion predominates. In this historical cohort-type observational study, in people infected with Andes Sur hantavirus during the years 2009 to 2019 who was assisted in the public health subsector of San Carlos de Bariloche (Argentina), it was sought to identify factors that could predict poor evolution (cardiopulmonary syndrome and death). For this, the risk for each of the variables was characterized and, to obtain key information about the relationships between them, a multiple correspondence analysis was also applied. During the study period, 38 people were included. The mean age was 35 years. Person-to-person contagion was suspected in 10/38 (26.8%) cases. 21.1% (8/28) presented a hantavirus pulmonary syndrome at the time of diagnosis, while 55.3% (21/38) developed it during their evolution, and 44.7% (17/38) of those infected died during hospitalization. Age over 15 years and thrombocytopenia were associated with a higher risk of clinical progression, while mild forms or asymptomatic people, person-to-person transmission, or during an epidemiological outbreak, were associated with a lower risk of death.

Las infecciones por hantavirus, ocurren a través de la inhalación de aerosoles provenientes de excretas de roedores infectados. Estos virus causan síndrome cardiopulmonar en el caso de la variante Andes Sur, con una mortalidad que puede alcanzar el 50%. Se presenta como casos esporádicos o en pequeños conglomerados, en los que predomina el contagio interhumano. En este estudio observacional de tipo cohorte histórica, en personas infectadas con hantavirus Andes Sur durante los años 2009 a 2019 que fueron asistidas en el subsector público de salud de San Carlos de Bariloche(Argentina), se buscó identificar factores que pudieran predecir mala evolución (síndrome cardiopulmonar y muerte). Para ello se caracterizó el riesgo para cada una de las variables y, para obtener información clave sobre las relaciones entre las mismas, se aplicó además un análisis de correspondencias múltiples. Durante el período de estudio, 38 personas fueron incluidas. La edad media fue de 35 años. Se sospechó contagio de persona a persona en 10/38 (26.8%) casos. El 21.1% (8/28) tuvo al momento del diagnóstico un síndrome pulmonar por hantavirus. Mientras que, 55.3% (21/38) lo desarrolló durante su evolución y 44.7% (17/38) de los infectados fallecieron durante la internación. La edad mayor a 15 años y la plaquetopenia, se asociaron con un mayor riesgo de progresión clínica, mientras que las formas de leves o las personas asintomáticas, el contagio persona a persona o durante un brote epidemiológico, se asociaron con un menor riesgo de muerte.

Correction: Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0241955.].

Bias as a source of inconsistency in ivermectin trials for COVID-19: A systematic review. Ivermectin's suggested benefits are mainly based on potentially biased results.

OBJECTIVE: The objective of this systematic review is to summarize the effects of ivermectin for the prevention and treatment of patients with COVID-19 and to assess inconsistencies in results from individual studies with focus on risk of bias due to methodological limitations. METHODS: We searched the L.OVE platform through July 6, 2021 and included randomized trials (RCTs) comparing ivermectin to standard or other active treatments. We conducted random-effects pairwise meta-analysis, assessed the certainty of evidence using the GRADE approach and performed sensitivity analysis excluding trials with risk of bias. RESULTS: We included 29 RCTs which enrolled 5592 cases. Overall, the certainty of the evidence was very low to low suggesting that ivermectin may result in important benefits. However, after excluding trials classified as "high risk" or "some concerns" in the risk of bias assessment, most estimates of effect changed substantially: Compared to standard of care, low certainty evidence suggests that ivermectin may not reduce mortality (RD 7 fewer per 1000) nor mechanical ventilation (RD 6 more per 1000), and moderate certainty evidence shows that it probably does not increase symptom resolution or improvement (RD 14 more per 1000) nor viral clearance (RD 12 fewer per 1000). CONCLUSION: Ivermectin may not improve clinically important outcomes in patients with COVID-19 and its effects as a prophylactic intervention in exposed individuals are uncertain. Previous reports concluding important benefits associated with ivermectin are based on potentially biased results reported by studies with substantial methodological limitations. Further research is needed.

[Clinical practice guideline: tocilizumab for patients with severe and critical COVID-19]. / Guía de práctica clínica: tocilizumab para pacientes con COVID-19 grave o crítica.

In COVID-19, there are states of hyperinflammation in severely or critically ill people, where immunosuppression and blocking of IL-6 receptors could be beneficial. Faced with this situation, with the support of a methods group using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, about the use of tocilizumab for patients with severe and critical illness coronavirus. This guide focuses on making recommendations for the use of tocilizumab in patients with severe and critical COVID-19. This clinical practice guideline was prepared following the WHO guideline development methods. A multidisciplinary development group was formed, with clinical and health policy experts, methodologists and users. Panel and methods group members signed a declaration of conflict of interest. We searched the Epistemonikos Foundation's LOVE database for randomized studies up to April 17, 2021. The synthesis and evidence profiles were prepared using the GRADE approach and an economic model was developed. Among hospitalized adults with progressive severe or critical COVID-19, the guideline panel su ggests tocilizumab. (Conditional recommendation, Moderate certainty of evidence) Implementation considerations. A. Dose: 8 mg/kg of actual weight, single-dose, intravenously), maximum dose 800 mg; B. Administer dexamethasone 8 mg (or equivalent) for 10 days together with tocilizumab; C. The recommendation applies to: 1. patients with severe disease defined as SpO2 = 92% with room air and/or patients receiving supplemental oxygen (including a high-flow nasal cannula and non-invasive ventilation); 2. critically ill patients: requiring invasive mechanical ventilation.

En COVID-19, existen estados de hiperinflamación, donde la inmunosupresión y bloqueo de receptores de IL-6 podría ser beneficiosa. Se desarrolló una guía de práctica clínica con apoyo del grupo metodológico, utilizando el método GRADE (Grading of Recommendations Assessment, Development and Evaluation) acerca del uso de tocilizumab para pacientes con COVID-19 grave y crítica. Siguiendo métodos de elaboración de guías de la OMS, se conformó un grupo multidisciplinario compuesto por expertos temáticos clínicos y en políticas públicas, metodólogos y usuarios. Todos lo s participantes del panel y del grupo desarrollador firmaron una declaración de conflicto de interés. Se realizaron búsquedas de estudios aleatorizados hasta el 17 de abril de 2021, en la base de datos LOVE de la fundación Epistemonikos. Se elaboró la síntesis y los perfiles de evidencia utilizando el enfoque GRADE y se desarrolló un modelo para valorar el impacto presupuestario de la incorporación de tociliuzmab. Posteriormente, la recomendación fue graduada en un panel de expertos temáticos. Se sugiere utilizar tocilizumab en hospitalizados con COVID-19 grave y crítica. Recomendación condicional, certeza en la evidencia moderada. Consideraciones para la implementación. A. Dosis: 8 mg/kg de peso real, única dosis, por vía endovenosa, dosis máxima 800 mg; B. Administrar dexametasona 8 mg (o equivalente) por 10 días conjuntamente con tocilizumab; C. La recomendación aplica a: 1. pacientes con enfermedad grave definida como SpO2 = 92% con aire ambiente y/o pacientes que reciben oxígeno suplementario (incluyendo cánula nasal de alto flujo y ventilación no invasiva); 2. pacientes con enfermedad crítica (ventilación mecánica invasiva).

[Risk of Publication Bias in Therapeutic Interventions for COVID-19Risco de viés de publicação em intervenções terapêuticas para a COVID-19]. / Riesgo de sesgo de publicación en intervenciones terapéuticas para la COVID-19.

This article describes publication bias, its most frequent causes, its characteristics, the regulatory tools to avoid it, and some statistical techniques to analyze it. These techniques are explained and applied to three therapeutic interventions related to the 2019 coronavirus disease (COVID-19): corticosteroids, ivermectin, and tocilizumab. Risk of publication bias was detected for ivermectin and tocilizumab. Systematic reviews and meta-analyses are secondary research designs that provide a reference to guide decision-making. They are prone to different types of bias, i.e., a systematic deviation in the results. Even if carried out with methodological rigor, their validity can be threatened by publication bias. This is defined as the act of concealing or delaying publication, withholding data arising from research studies, or both. Up to half of controlled trials remain unpublished. During the H1N1 virus pandemic, publication bias from industry-funded studies led to the recommendation and large-scale procurement of oseltamivir, a drug that later proved to have no relevant beneficial effects. Two-thirds of clinical trial funding for COVID-19 comes from the pharmaceutical industry. In the context of the COVID-19 pandemic, studies are published at an accelerated pace, making it very important to understand and identify publication bias. To reduce publication bias it is necessary to regulate the registration and publication of clinical trials, but this requires coordination among countries and international bodies. It is important to suspect and attempt to identify publication bias for decision making.

Este artigo descreve o viés de publicação, suas causas mais frequentes, suas características, as ferramentas regulatórias para evitá-lo e algumas técnicas estatísticas para analisá-lo. Essas técnicas são explicadas e aplicadas a três intervenções terapêuticas relacionadas à doença pelo coronavírus 2019 (COVID-19, na sigla em inglês): corticoides, ivermectina e tocilizumabe. Detectou-se risco de viés de publicação para ivermectina e tocilizumabe. As revisões sistemáticas e as meta-análises são delineamentos de pesquisa secundária que constituem uma referência para orientar a tomada de decisão. Estão propensas a diferentes tipos de viés, que é um desvio sistemático nos resultados. Mesmo tendo sido desenvolvidas com rigor metodológico, sua validade pode ser ameaçada pelo viés de publicação, que é definido como o ato de ocultar ou atrasar a publicação, reter dados de pesquisa ou ambos. Até metade dos estudos controlados realizados jamais são publicados. Durante a pandemia pelo vírus H1N1, o viés de publicação de estudos financiados pela indústria levou à recomendação e à compra, em grande escala, do medicamento oseltamivir que, mais tarde, ficou conhecido por não ter efeitos benéficos relevantes. Dois terços do financiamento para os ensaios clínicos referentes à COVID-19 vêm da indústria farmacêutica. No contexto da atual pandemia de COVID-19, os estudos vêm sendo publicados em ritmo acelerado; portanto, é fundamental conhecer e identificar o viés de publicação. Para reduzi-lo, é necessário regulamentar o registro de a publicação de ensaios clínicos, o que requer coordenação entre países e organismos internacionais. É importante suspeitar e tentar identificar o viés de publicação para a tomada de decisão.

Riesgo de sesgo de publicación en intervenciones terapéuticas para la COVID-19

[RESUMEN]. En este artículo se describe el sesgo de publicación, sus causas más frecuentes, sus características, las herramientas regulatorias para evitarlo y algunas técnicas estadísticas para analizarlo. Se explican y aplican estas técnicas a tres intervenciones terapéuticas relacionadas con la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés): corticoides, ivermectina y tocilizumab; se detectó riesgo de sesgo de publicación para ivermectina y tocilizumab. Las revisiones sistemáticas y los metaanálisis son diseños de investigación secundaria que constituyen una referencia para guiar la toma de decisiones. Son propensos a distintos tipos de sesgo, que es una desviación sistemática en los resultados. Aun desarrollados con rigor metodológico, su validez puede verse amenazada por el sesgo de publicación. Este se define como el acto de ocultar o retrasar la publicación, retener datos surgidos de los estudios de investigación, o ambos. Hasta la mitad de los ensayos controlados que se realizan permanecen sin publicarse. Durante la pandemia por virus H1N1, el sesgo de publicación de estudios financiados por la industria llevó a recomendar y comprar en gran escala el fármaco oseltamivir que, luego se supo, no tenía efectos beneficiosos relevantes. Dos tercios del financiamiento de los estudios clínicos para COVID-19 provienen de la industria farmacéutica. En el contexto de la pandemia actual por COVID-19, se publican estudios a un ritmo acelerado, por lo que resulta de gran trascendencia conocer e identificar el sesgo de publicación. Para reducir el sesgo de publicación es necesario regular el registro y la publicación de ensayos clínicos, pero esto requiere una coordinación de los países y organismos internacionales. Es importante sospechar e intentar identificar el sesgo de publicación para la toma de decisiones.

[ABSTRACT]. This article describes publication bias, its most frequent causes, its characteristics, the regulatory tools to avoid it, and some statistical techniques to analyze it. These techniques are explained and applied to three therapeutic interventions related to the 2019 coronavirus disease (COVID-19): corticosteroids, ivermectin, and tocilizumab. Risk of publication bias was detected for ivermectin and tocilizumab. Systematic reviews and meta-analyses are secondary research designs that provide a reference to guide decision-making. They are prone to different types of bias, i.e., a systematic deviation in the results. Even if carried out with methodological rigor, their validity can be threatened by publication bias. This is defined as the act of concealing or delaying publication, withholding data arising from research studies, or both. Up to half of controlled trials remain unpublished. During the H1N1 virus pandemic, publication bias from industry-funded studies led to the recommendation and large-scale procurement of oseltamivir, a drug that later proved to have no relevant beneficial effects. Two-thirds of clinical trial funding for COVID-19 comes from the pharmaceutical industry. In the context of the COVID-19 pandemic, studies are published at an accelerated pace, making it very important to understand and identify publication bias. To reduce publication bias it is necessary to regulate the registration and publication of clinical trials, but this requires coordination among countries and international bodies. It is important to suspect and attempt to identify publication bias for decision making.

[RESUMO]. Este artigo descreve o viés de publicação, suas causas mais frequentes, suas características, as ferramentas regulatórias para evitá-lo e algumas técnicas estatísticas para analisá-lo. Essas técnicas são explicadas e aplicadas a três intervenções terapêuticas relacionadas à doença pelo coronavírus 2019 (COVID-19, na sigla em inglês): corticoides, ivermectina e tocilizumabe. Detectou-se risco de viés de publicação para ivermectina e tocilizumabe. As revisões sistemáticas e as meta-análises são delineamentos de pesquisa secundária que constituem uma referência para orientar a tomada de decisão. Estão propensas a diferentes tipos de viés, que é um desvio sistemático nos resultados. Mesmo tendo sido desenvolvidas com rigor metodológico, sua validade pode ser ameaçada pelo viés de publicação, que é definido como o ato de ocultar ou atrasar a publicação, reter dados de pesquisa ou ambos. Até metade dos estudos controlados realizados jamais são publicados. Durante a pandemia pelo vírus H1N1, o viés de publicação de estudos financiados pela indústria levou à recomendação e à compra, em grande escala, do medicamento oseltamivir que, mais tarde, ficou conhecido por não ter efeitos benéficos relevantes. Dois terços do financiamento para os ensaios clínicos referentes à COVID-19 vêm da indústria farmacêutica. No contexto da atual pandemia de COVID-19, os estudos vêm sendo publicados em ritmo acelerado; portanto, é fundamental conhecer e identificar o viés de publicação. Para reduzi-lo, é necessário regulamentar o registro e a publicação de ensaios clínicos, o que requer coordenação entre países e organismos internacionais. É importante suspeitar e tentar identificar o viés de publicação para a tomada de decisão.

Guía de práctica clínica: tocilizumab para pacientes con COVID-19 grave o crítica / Clinical practice guideline: tocilizumab for patients with severe and critical COVID-19

Resumen En COVID-19, existen estados de hiperinflamación, donde la inmunosupresión y bloqueo de receptores de IL-6 podría ser beneficiosa. Se desarrolló una guía de práctica clínica con apoyo del gru po metodológico, utilizando el método GRADE (Grading of Recommendations Assessment, Development and Evaluation) acerca del uso de tocilizumab para pacientes con COVID-19 grave y crítica. Siguiendo métodos de elaboración de guías de la OMS, se conformó un grupo multidisciplinario compuesto por expertos temáticos clí nicos y en políticas públicas, metodólogos y usuarios. Todos lo s participantes del panel y del grupo desarrollador firmaron una declaración de conflicto de interés. Se realizaron búsquedas de estudios aleatorizados hasta el 17 de abril de 2021, en la base de datos L.OVE de la fundación Epistemonikos. Se elaboró la síntesis y los perfiles de evidencia utilizando el enfoque GRADE y se desarrolló un modelo para valorar el impacto presupuestario de la incorporación de tociliuzmab. Posteriormente, la recomendación fue graduada en un panel de expertos temáti cos. Se sugiere utilizar tocilizumab en hospitalizados con COVID-19 grave y crítica. Recomendación condicional, certeza en la evidencia moderada. Consideraciones para la implementación. A. Dosis: 8 mg/kg de peso real, única dosis, por vía endovenosa, dosis máxima 800 mg; B. Administrar dexametasona 8 mg (o equivalente) por 10 días conjuntamente con tocilizumab; C. La recomendación aplica a: 1. pacientes con enfermedad grave definida como SpO2 ≤ 92% con aire ambiente y/o pacientes que reciben oxígeno suplementario (incluyendo cánula nasal de alto flujo y ventilación no invasiva); 2. pacientes con enfermedad crítica (ventilación mecánica invasiva).

Abstract In COVID-19, there are states of hyperinflammation in severely or critically ill people, where immu nosuppression and blocking of IL-6 receptors could be beneficial. Faced with this situation, with the support of a methods group using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, about the use of tocilizumab for patients with severe and critical illness coronavirus. This guide fo cuses on making recommendations for the use of tocilizumab in patients with severe and critical COVID-19. This clinical practice guideline was prepared following the WHO guideline development methods. A multidisciplinary development group was formed, with clinical and health policy experts, methodologists and users. Panel and methods group members signed a declaration of conflict of interest. We searched the Epistemonikos Founda tion's L.OVE database for randomized studies up to April 17, 2021. The synthesis and evidence profiles were prepared using the GRADE approach and an economic model was developed. Among hospitalized adults with progressive severe or critical COVID-19, the guideline panel su ggests tocilizumab. (Conditional recommendation, Moderate certainty of evidence) Implementation considerations. A. Dose: 8 mg/kg of actual weight, single-dose, intravenously), maximum dose 800 mg; B. Administer dexamethasone 8 mg (or equivalent) for 10 days together with tocilizumab; C. The recommendation applies to: 1. patients with severe disease defined as SpO2 ≤ 92% with room air and/or patients receiving supplemental oxygen (including a high-flow nasal cannula and non-invasive ventilation); 2. critically ill patients: requiring invasive mechanical ventilation.

High-flow oxygen nasal cannula for treating acute bronchiolitis in infants: A systematic review and meta-analysis. / Oxígeno con cánula de alto flujo para el tratamiento de la bronquiolitis aguda del lactante: revisión sistemática y metanálisis.

INTRODUCTION: Oxygen therapy through a high-flow nasal cannula is thought to improve the work of breathing and the comfort of patients with acute bronchiolitis. It is widely used in hospital wards and critical care of pediatric patients. However, there is uncertainty on the magnitude of the effect on critical and important outcomes in these patients. OBJECTIVES: The objective of this review is to evaluate the available evidence on the use of oxygen administered through high-flow cannula versus low-flow oxygen for the treatment of acute bronchiolitis in children under two years of age. METHODOLOGY: We carried out a systematic review and a meta-analysis following the PRISMA standards for reporting. The search was carried out in electronic databases by two researchers independently. The evidence was summarized using the GRADE methodology. RESULTS: Six randomized and non-randomized clinical trials were included, including 1867 individuals younger than 24 months of age with acute bronchiolitis in pediatric emergency, hospitalization, and intensive care services. Mortality was not reported in the included studies. Treatment failure occurred in 108/933 in the high flow group and 233/934 in the low flow group (relative risk: 0.46; 95% confidence interval: 0.35 to 0.62), which shows 11.7% less treatment failure (95% confidence interval between 7.9% and 14.5% less) in the high flow group with a number needed to treat of 7.5 (95% confidence interval 6 to 10) with moderate certainty in the evidence. CONCLUSION: The use of humidified and heated oxygen with high flow compared to oxygen at low flow is probably associated with decreased treatment failure in children younger than two years with acute bronchiolitis. There is uncertainty about the effect on hospitalization days and clinical progression.

INTRODUCCIÓN: La terapia con oxígeno a través de cánula nasal de alto flujo actuaría mejorando el trabajo de la respiración y el confort de los pacientes con bronquiolitis aguda. Su uso se encuentra ampliamente difundido en distintas áreas de internación y cuidados críticos de pacientes pediátricos. Sin embargo, existe incertidumbre en la magnitud del efecto en desenlaces críticos e importantes en estos pacientes. OBJETIVOS: Evaluar la evidencia disponible acerca del uso de oxígeno administrado a través de cánulas de alto flujo, frente a oxígeno a bajo flujo para el tratamiento de la bronquiolitis aguda en menores de dos años. METODOLOGÍA: Realizamos una revisión sistemática y metanálisis siguiendo los estándares PRISMA para el reporte de la misma. La búsqueda fue realizada en bases de datos electrónicas por dos investigadores de forma independiente. La evidencia fue resumida utilizando la metodología GRADE. RESULTADOS: Se incluyeron seis ensayos clínicos aleatorizados y no aleatorizados, incluyendo 1867 individuos menores de 24 meses de edad con bronquiolitis aguda en servicios de emergencias, internación y cuidados intensivos pediátricos. La mortalidad no fue reportada en los estudios incluidos. El fracaso del tratamiento ocurrió en 108/933 en el grupo alto flujo y 233/934 en el grupo bajo flujo (riesgo relativo: 0,46; intervalo de confianza 95%: 0,35 a 0,62), lo que muestra 11,7% menos fracaso de tratamiento (intervalo de confianza 95%: entre 7,9% y 14,5% menos) en el grupo alto flujo con un número necesario a tratar de 7,5 (de 6 a 10) con moderada certeza en la evidencia. CONCLUSIÓN: La utilización de oxígeno humidificado y calentado con alto flujo en comparación con el oxígeno a bajo flujo probablemente se asocie con una disminución del fracaso de tratamiento en niños menores de dos años con bronquiolitis aguda. Existe incertidumbre en el efecto sobre los días de internación y puntajes clínicos de progresión.

Risk of publication bias in therapeutic interventions for COVID-19 / Riesgo de sesgo de publicación en intervenciones terapéuticas para el COVID-19

Systematic reviews and meta-analyses are secondary research designs that constitute a reference to guide decision-making. Faced with the pandemic, many investigations are published at an accelerated rate, which is why various organizations have proposed to keep them updated through "live reviews". Even if developed with great methodological rigor, publication bias can represent a threat to their validity. The characteristics of publication bias, the regulatory ways to avoid it, and statistical tools to suspect it are described. Publication bias is defined as hiding or delaying publication and / or withholding data from research studies. Up to half of the controlled trials that are conducted remain unpublished, due to various interests. A recent and shocking example was that of Oseltamivir during the H1N1 pandemic. The delay in publishing results of studies funded by the industry led to the purchase of a drug that, later, it was learned, had no relevant beneficial effects. Various initiatives propose regulating the publication and registration of clinical trials  to reduce this bias, and some statistical techniques allow us to suspect it. It is exemplified by a statistical analysis to assess publication bias in three therapeutic interventions related to COVID-19: Corticosteroids, Ivermectin and Tocilizumab.

Las revisiones sistemáticas y meta-análisis son diseños de investigación secundaria que constituyen una referencia para guiar la toma de decisiones. Ante la pandemia, un gran número de investigaciones se publican a un ritmo acelerado, por lo que diversas organizaciones han propuesto mantenerlas actualizadas a través de "revisiones vivas". Aun siendo desarrollados con gran rigor metodológico, el sesgo de publicación puede representar una amenaza a su validez. Se describen las características de los sesgos de publicación, las vías regulatorias para evitarlo y herramientas estadísticas para  sospecharlo. Se define sesgo de publicación como el hecho de ocultar o retrasar la publicación y/o retener datos surgidos de los estudios de investigación. Hasta la mitad de los ensayos controlados que se realizan permanecen sin publicarse, a causa de diversos intereses. Un ejemplo reciente e impactante fue el acontecido con oseltamivir durante la pandemia H1N1. El ocultamiento y la demora en publicar resultados de estudios financiados por la industria llevó a comprar un medicamento que, luego se supo, no tenía efectos beneficiosos relevantes. Diversas iniciativas proponen regular la publicación y registro de ensayos clínicos, para reducir este sesgo, y algunas técnicas estadísticas permiten sospecharlo. Se ejemplifica mediante un análisis estadístico de valoración de sesgo de publicación en tres intervenciones terapéuticas relacionadas con COVID-19: corticoides, ivermectina y tocilizumab.

Actualizaciones basadas en evidencia COVID-19 azitromicina para el tratamiento de pacientes con COVID-19 / Evidence-based updates COVID-19 azithromycin for the treatment of COVID-19 patients

La enfermedad por el Coronavirus 2019 (COVID-19 - Coronavirus Disease 2019) es una patología respiratoria de humanos producida por la infección por un nuevo coronavirus identificado con la sigla SARS-CoV-2.1 El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaro al COVID-19 como una pandemia, y desde ese momento hasta el 24 de junio del 2021 se ha reportado aproximadamente para Argentina más de 4.000.000 casos confirmados y 90.986 muertes.1,2 Al no existir un tratamiento farmacológico específico contra el virus hasta el momento, aunque los esteroides sistémicos han demostrado reducir la mortalidad en pacientes hospitalizados por COVID-19 con complicaciones respiratorias graves y que las heparinas son efectivas en la prevención de la trombosis venosa profunda también en casos graves, la comunidad científica se ha enfocado en la búsqueda y desarrollo de intervenciones antivirales y en resignificar diferentes tipos de fármacos que se utilizan en otras indicaciones. El presente informe pretende evaluar si el tratamiento empírico con azitromicina es eficaz, seguro y resulta conveniente para el tratamiento de pacientes con COVID-19 en Argentina