Do immunosuppressive treatments influence immune responses against adenovirus-based COVID-19 vaccines in patients with multiple sclerosis? An Argentine multicenter study.

Introduction: There are no reports in LATAM related to longitudinal humoral and cellular response to adenovirus based COVID-19 vaccines in people with Multiple Sclerosis (pwMS) under different disease modifying therapies (DMTs) and neutralization of the Omicron and Wuhan variants of SARS-COV-2. Methods: IgG anti- SARS-COV-2 spike titer were measured in a cohort of 101 pwMS under fingolimod, dimethyl fumarate, cladribine and antiCD20, as well as 28 healthy controls (HC) were measured 6 weeks after vaccination with 2nd dose (Sputnik V or AZD1222) and 3nd dose (homologous or heterologous schedule). Neutralizing capacity was against Omicron (BA.1) and Wuhan (D614G) variants and pseudotyped particles and Cellular response were analyzed. Results: Multivariate regression analysis showed anti-cd20 (ß= -,349, 95% CI: -3655.6 - -369.01, p=0.017) and fingolimod (ß=-,399, 95% CI: -3363.8 - -250.9, p=0.023) treatments as an independent factor associated with low antibody response (r2 adjusted=0.157). After the 2nd dose we found a correlation between total and neutralizing titers against D614G (rho=0.6; p<0.001; slope 0.8, 95%CI:0.4-1.3), with no differences between DMTs. Neutralization capacity was lower for BA.1 (slope 0.3, 95%CI:0.1-0.4). After the 3rd dose, neutralization of BA.1 improved (slope: 0.9 95%CI:0.6-1.2), without differences between DMTs. A fraction of pwMS generated anti-Spike CD4+ and CD8+ T cell response. In contrast, pwMS under antiCD20 generated CD8+TNF+IL2+ response without differences with HC, even in the absence of humoral response. The 3rd dose significantly increased the neutralization against the Omicron, as observed in the immunocompetent population. Discussion: Findings regarding humoral and cellular response are consistent with previous reports.

Analysis of long COVID in health personnel: comparing gender and work factors.

INTRODUCTION: This study aimed to describe the reported prevalence of post-COVID-19 syndrome and its characteristics by gender, profession, and other determinants among health care workers. METHODS: A cross-sectional study was conducted among health workers with a history of COVID-19 in Latin America, and the 2030 responses from Argentina were selected for this analysis. Sociodemographic information, as well as data on initial course of COVID-19, and the persistence of 21 symptoms beyond the first month, their severity, clinical evolution, and health care demands were collected. RESULTS: The reported prevalence of post-COVID-19 syndrome was higher in women for each of the symptom clusters studied. Severity of the initial symptoms, female gender, nursing profession, multi-employment, and working in emergency areas were all independent variables. DISCUSSION: The greater strain of health care workers during the pandemic -highly feminized- and the associated gender conditions may partially explain these findings.

Introducción: El objetivo del estudio fue describir la prevalencia del reporte de síndrome post-COVID-19 y sus características según género, profesión y otros determinantes sociales, en personal de salud. Métodos: Se realizó un estudio de corte transversal en profesionales de salud con antecedentes de COVID-19 en América Latina, y para este análisis se seleccionaron las 2030 respuestas de Argentina. Se recolectaron datos sociodemográficos, información sobre el curso inicial de la enfermedad COVID-19, y persistencia de 21 síntomas más allá del primer mes, su gravedad, evolución clínica y requerimiento de servicios de salud. Resultados: Se identificó que la prevalencia reportada de síndrome post-COVID-19 fue mayor en mujeres para cada uno de los grupos de síntomas explorados. La gravedad del cuadro inicial, el género femenino, la profesión de enfermería, el multiempleo y trabajar en áreas de emergencia fueron variables independientes. Discusión: La mayor sobrecarga del personal de salud durante la pandemia ­altamente feminizado­ y las determinaciones de género asociadas podrían explicar parcialmente estos hallazgos.

[Excess deaths in Argentina during the COVID-19 pandemic: analysis of mortality between 2020 and 2022]. / Exceso de muertes en Argentina durante la pandemia por COVID-19: análisis de la mortalidad entre 2020 y 2022.

Reports of excess mortality during the COVID-19 pandemic in Argentina have been partial and fragmented so far. This study aimed to quantify excess deaths and explore their demographic, temporal, and geographic distribution during the period 2020-2022. Using data from 1 192 963 death records from vital statistics and population projections, expected mortality was estimated using regression models. Excess death was calculated as the difference between observed and expected mortality. An excess of 160 676 deaths (95% CI 146 861 to 174 491) was estimated, representing a rate of 116.9 (95% CI 115.5 to 118.3) additional deaths per 100 000 personyears. Significant heterogeneity was found among the different argentine provinces. The results indicate an uneven impact of the pandemic, with higher excess mortality rates in some regions and more vulnerable age groups. These patterns suggest the need for differentiated strategies of healthcare response and support to the most vulnerable populations in scenarios of new epidemics.

Los reportes del exceso de mortalidad durante la pandemia por COVID-19 en Argentina han sido parciales y fragmentados hasta el momento. Este estudio se propuso cuantificar el exceso de muertes y explorar su distribución demográfica, temporal y geográfica durante el periodo 2020-2022. Utilizando datos de 1 192 963 registros de muertes de estadísticas vitales y proyecciones poblacionales, se estimó la mortalidad esperada mediante modelos de regresión. El exceso de muertes se calculó como la diferencia entre la mortalidad observada y la esperada. Se estimó un exceso de 160 676 muertes (IC 95% 146 861 a 174 491), representando una tasa de 116.9 muertes (IC 95% 115.5 a 118.3) adicionales por cada 100 000 personas-año. Se verificó una significativa heterogeneidad entre las distintas provincias argentinas. Los resultados indican un impacto desigual de la pandemia, con mayores tasas de exceso de mortalidad en algunas regiones y grupos de edad más vulnerables. Estos patrones sugieren la necesidad de estrategias diferenciadas de respuesta sanitaria y apoyo a las poblaciones más vulnerables en escenarios de nuevas epidemias.

Evaluating the implementation of a hypertension program based on mHealth and community pharmacies integration to primary care centers at a municipality level in Argentina during the COVID-19 pandemic.

Introduction: While pharmacists-led interventions in hypertension have proven effective in high-income countries, their implementation and impact in low- and middle-income countries (LMIC) remain limited. This study assessed the implementation and outcomes of the hypertension program FarmaTeCuida (FTC), which integrated community pharmacies into the public primary care level using information and communication technologies. The study took place during the pandemic in General Pueyrredón, Buenos Aires, Argentina, so modifications to the implementation strategy and expected outcomes were also analyzed. Methods: A mixed-methods study was conducted using the non-adoption, abandonment, scaling-up, dissemination, and sustainability (NASSS) conceptual model. Qualitative in-depth interviews were conducted with key stakeholders using snowball sampling until thematic saturation was achieved. The quantitative approach employed a quasi-experimental, prospective, longitudinal design in a cohort of hypertensive patients enrolled in the FTC program since October 2020 to March 2022. Adoption, access, adherence to follow-up, and blood pressure levels were assessed. Clinical outcomes were compared to a cohort of hypertensive patients attending primary health care centers (PHCCs) in 2021 but not enrolled in the FTC program. Routine data from this cohort was obtained from the municipal health information system (HIS). Results: Out of 33 PHCCs, 23 adopted the FTC program, but only four collaborated with community pharmacies. A total of 440 patients were recruited, with 399 (91%) enrolled at PHCCs. Hypertension was detected in 63% (279/440) of cases at the first visit (113 were possible hypertensive patients; 26 new hypertensive patients and 140 already diagnosed). During follow-up, FTC identified 52 new hypertensive patients (12% out of 440). Reduction of systolic blood pressure (SBP) was observed in patients enrolled in both the FTC program and the comparison group over 60 days. In the multivariate analysis that included all hypertensive patient (FTC and HIS) we found strong evidence that for each month of follow up, SBP was reduced by 1.12 mmHg; however, we did not find any significant effect of the FTC program on SBP trend (interaction FTC*months has a p-value = 0.23). The pandemic was identified as the main reason for the program's underperformance; in addition we identified barriers related to technology, patient suitability, implementation team characteristics, and organizational factors. Discussion: Our study, grounded in the NASSS model, highlights the profound complexity of introducing innovative strategies in low- and middle-income settings. Despite substantial challenges posed by the pandemic, these obstacles provided valuable insights, identified areas for improvement, and informed strategies essential for reshaping the care paradigm for conditions like hypertension in resource-constrained environments.

COVID-19 mortality: educational inequalities and socio-spatial context in two provinces of Argentina. / Mortalidad por COVID-19: desigualdades educativas y contexto socio-espacial en dos provincias de Argentina.

Motivation for the study. There are very few studies on the educational inequalities in COVID-19 mortality, taking into account social contextual factors. Main findings. We found educational inequalities of COVID-19 mortality during both the 2020 and 2021 waves, regardless of the level of poverty and urbanization in the departments of Mendoza and San Juan provinces (Argentina). Implications. Preventive policies should focus not only in areas with high levels of poverty, but also in areas with adults of low educational level. With the aim of describing the association between sociodemographic characteristics and contextual factors with COVID-19 mortality during 2020-2021 in the provinces of Mendoza and San Juan in Argentina, we conducted an ecological study, which included the sociodemographic factors: age, sex and educational level, and the contextual factors: poverty and urbanization at the departmental level. The analyses were estimated using negative binomial Bayesian hierarchical models. Educational inequalities existed regardless of socioeconomic context and level of urbanization. The exception was the age group 65 years and older during 2021, which, regardless of educational level, showed a higher risk of death by COVID-19 in departments with high levels of structural poverty. In conclusion, educational inequality is an indicator of social inequality that increases vulnerability to COVID-19 mortality.

Con el objetivo de describir la asociación entre las características sociodemográficas y factores contextuales con la mortalidad por COVID-19, durante 2020-2021 en las provincias de Mendoza y San Juan en Argentina se realizó un estudio de tipo ecológico, donde los factores sociodemográficos fueron la edad, el sexo y el nivel educativo y contextuales la pobreza y la urbanización a nivel departamental. Los análisis se estimaron mediante modelos jerárquicos bayesianos binomial negativos. Existieron desigualdades educacionales independientemente del contexto socioeconómico y el nivel de urbanización. La excepción fue el grupo etario de 65 a más años durante 2021 que, independientemente del nivel educativo, mostró un riesgo de muerte por COVID-19 mayor en departamentos con niveles altos de pobreza estructural. En conclusión, la desigualdad educativa es un indicador de desigualdad social que aumenta la vulnerabilidad para la mortalidad por COVID-19. Motivación para realizar el estudio. Existen muy pocos estudios que den cuenta de las desigualdades educacionales de la mortalidad por COVID-19, tomando en cuenta factores sociales contextuales. Principales hallazgos. Durante ambas olas de 2020 y 2021, se encontraron desigualdades educativas de la mortalidad por COVID-19, independientemente del nivel de pobreza y de urbanización de los departamentos de las provincias de Mendoza y San Juan (Argentina). Implicancias. Se sugiere focalizar políticas preventivas no sólo en áreas con niveles altos de pobreza, sino también a escala de aquellos hogares con personas adultas de nivel educativo bajo.

Cumplimiento de las recomendaciones de la OMS para la notificación de COVID-19 en Argentina

Introducción : La Organización Mundial de la Salud (OMS) efectuó recomendaciones en relación con la recopilación y notificación de datos agregados semanales de COVID-19. Objetivo : Investigar el grado de cumplimiento de las recomendaciones elaboradas por la OMS para la notificación de casos y muertes de COVID-19 en la Argentina durante el año 2020 a 2022, y comparar la notificación de muertes con el número de defunciones por COVID-19 consolidadas en el registro de estadísticas vitales del país. Materiales y métodos : Estudio cuantitativo descriptivo, basado en revisión documental y en fuentes de datos secundarias. Se utilizó los reportes diarios de información epidemiológica y la base de datos Dataset, COVID-19 casos registrados en la República Argentina. Adicionalmente, para estimar la omisión en los registros epidemiológicos de fallecimientos por COVID-19 en los años 2020 y 2021, se cotejaron los resultados de las bases de datos Dataset COVID-19 con la base de las Estadísticas vitales de mortalidad por causa de defunción, proporcionadas por la Dirección de Estadísticas e Información en Salud (DEIS). Se analizaron las variables recomendadas por la OMS para la notificación de casos y muertes por COVID-19. En cuanto a las consideraciones éticas relacionadas con el uso de la información utilizada en este trabajo, las bases de datos cumplen con lo estipulado por la Ley Nacional N° 17.622 de Resguardo del Secreto Estadístico, garantizando que la información mantiene el carácter confidencial y reservado del informante. Resultados: Del análisis de los reportes diarios, durante 2020 se observó que, de los 13 indicadores recomendados, 9 presentan datos algunos meses y los 4 restantes no se relevaron; en 2021 solo 7 indicadores presentaron datos algunos meses, y en 2022 solo 3 indicadores se continuaron informando. Respecto al análisis de la base de datos Dataset COVID-19, la mayoría fueron captadas. Respecto a la comparación de los valores de las defunciones registradas por el sistema de vigilancia epidemiológica y por la DEIS para los años 2020 y 2021, las muertes registradas fueron superiores en el registro de la DEIS (9,6% y 14,2%). Conclusiones : El Estado argentino cumplió con gran parte de las recomendaciones que establece la OMS para la notificación de los casos de COVID-19. Estudios posteriores deberían analizar otros componentes de la calidad de los datos, así como la oportunidad de los registros de defunciones, característica necesaria para la toma de decisiones en salud pública.

Introduction : The World Health Organization (WHO) establishes recommendations regarding the collection and reporting of weekly aggregated data on COVID-19. Objective : To investigate the degree of compliance with the recommendations made by the WHO for the reporting of COVID-19 cases and deaths in Argentina during the years 2020 to 2022, and to compare death notifications with the number of COVID-19 deaths recorded in the country's vital statistics registry. Materials and methods : Descriptive quantitative study, based on a documentary review and secondary data sources. Daily reports of epidemiological information and the Dataset database containing registered COVID-19 cases in the Argentine Republic were used. Additionally, to estimate the omission in the epidemiological records of COVID-19 deaths in the years 2020 and 2021, the results of the Dataset COVID-19 databases were compared with the vital statistics death registry on cause of death, provided by the Directorate of Statistics and Health Information (DEIS, by its acronym in Spanish). The variables recommended by the WHO for the reporting of COVID-19 cases and deaths were analyzed. As for the ethical considerations related to the use of the information in this study, the databases comply with the provisions of National Law 17,622 on the Protection of Statistical Secrecy, ensuring that the information remains confidential and reserved for the informant. Results : From the analysis of daily reports, it was observed that in 2020, out of the 13 recommended indicators, 9 had data for some months, and the remaining 4 were not reported. In 2021 only 7 indicators had data for some months, and in 2022 only 3 indicators continued to be reported. Regarding the analysis of the Dataset COVID-19 database, most data were captured. In comparing the values of deaths recorded by the epidemiological surveillance system and by the DEIS for the years 2020 and 2021, the deaths recorded were higher in the DEIS registry (9.6% and 14.2%). Conclusions : The Argentine state largely complied with the recommendations established by the WHO for the reporting of COVID-19 cases. Subsequent studies should analyze other components of data quality, as well as the timeliness of death records, a necessary characteristic for public health decision-making.

Depression and anxiety in the context of the COVID-19 pandemic: A 6-waves longitudinal study in the Argentine population.

PURPOSE: The pandemic has caused stress due to isolation, loss of loved ones, work and learning changes, financial instability, fear of infection, and uncertainty. It has negatively impacted mental health, particularly increasing anxiety, and depression symptoms. This study analyzed anxiety and depression symptoms over the first 25 months of the COVID-19 pandemic, considering age group, socioeconomic status, and gender. METHODS: A longitudinal study with 6 repeated measures was conducted, involving 988 adult participants from Argentina. Adapted versions of the BDI-II and STAI were administered through online questionnaires at 2, 14, 50, 130, 390, and 750 days since the start of the lockdown. RESULTS: The results showed a sustained increase in anxiety and depression symptoms up to 390 days, followed by a decrease in anxiety below initial levels at 750 days. Depressive symptoms significantly decreased after 750 days but remained higher than initial levels. CONCLUSION: Women consistently scored higher than men, lower socioeconomic status individuals reported more symptoms, and younger individuals had higher anxiety and depression, which decreased with age. Surprisingly, older individuals displayed better mental health indicators compared to the rest of the population.

The response to COVID-19 in Argentina, Brazil, and Mexico: challenges to national coordination of health policies.

The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President's denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government's initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.

Mental Health First Aid Guidelines for Argentina and Chile: Report on the study to adapt the Australian guidelines / Guías de primeros auxilios en salud mental para Argentina y Chile: un reporte del estudio de adaptación de las guías australianas.

Background: Mental health problems represent a growing global concern. This has intensified since the coronavirus pandemic and is also partly due to greater awareness of the extent of mental health problems and the lack of attention they have received over time. In many high-income countries, increases in service provision have been accompanied by efforts to increase the mental health literacy of the general population. One example of this in Australia, is the mental health first aid training program which is informed by the mental health first aid guidelines created to promote mental health literacy among the general population, reduce stigma, and enable lay people to provide timely support, and facilitate access to health services for a person developing a mental health problem or in a mental health crisis. Methods: Between March 2020 and May 2023, a consortium of researchers from Australia, Argentina and Chile carried out the cultural adaptation of five guidelines (drinking problems, depression, suicide risk, trauma, and psychosis) using the Delphi consensus methodology. Health professionals with expertise in each of the topics and people with lived experience (their own or as informal caregivers) from Argentina and Chile were grouped into separate panels. Over two survey rounds, they evaluated the items from the Australian guidelines and gave their opinion on the importance of their inclusion in the local guidelines. Additionally, they suggested items not included in the Australian guidelines. Results: This report presents the details of the methodology used and the most significant results of each of the five adapted guidelines, particularly, those of relevance to the Argentinian and Chilean context. The general acceptance of the role of the first aider stands out as an important outcome. However, in comparison to Australia, the first aider's role was reduced and the health professional role was expanded. Self-help recommendations were typically not endorsed by local experts, suggesting skepticism toward these strategies. Other specific recommendations for each of the guidelines are described and analyzed in this report. Conclusions: A study of the implementation of training courses based on these guidelines is required to make the necessary adaptations and determine their local usefulness.

Introducción: Los problemas de salud mental en la comunidad representan una preocupación global creciente, intensificada desde la pandemia por coronavirus y gracias a una mayor conciencia respecto de su extensión y del bajo nivel de atención que recibieron a lo largo del tiempo. En Australia se crearon las primeras guías de primeros auxilios en salud mental para promover un mayor conocimiento de temas de salud mental en la población general, brindar apoyo oportuno, facilitar el acceso a los servicios de salud por esta problemática, y disminuir el estigma asociado al padecimiento mental. Método: Un consorcio de investigadores de Australia, Argentina y Chile, entre marzo de 2020 y mayo de 2023, realizó la adaptación cultural de cinco guías (consumo problemático de alcohol, depresión, riesgo de suicidio, trauma, y psicosis) siguiendo la metodología de consenso Delphi. Profesionales expertos en cada uno de los temas y personas con experiencia vivida  (propia o como cuidadores informales) conformaron sendos paneles con miembros de Argentina y de Chile. En dos rondas de consulta evaluaron los ítems provenientes de las guías de Australia y opinaron sobre su pertinencia para formar parte de las guías locales. Adicionalmente, sugirieron ítems que no estaban contemplados en las guías australianas. Resultados: El presente reporte presenta el detalle de la metodología empleada y los resultados más significativos de cada una de las cinco guías adaptadas y, particularmente, su aplicabilidad para Argentina y Chile. Sobresale la aceptación general del rol del asistente de primeros auxilios en salud mental, aunque también con limitaciones en el rol y funciones en favor del privilegio de profesionales de la salud. Las recomendaciones de auto-ayuda fueron mayoritariamente no aceptadas por los expertos locales, sugiriendo desconfianza respecto de estas estrategias. Otras recomendaciones específicas para cada una de las guías se describen y analizan en este reporte. Conclusiones: Se requiere un estudio de la implementación de la capacitación en base a estas guías para realizar ulteriores adaptaciones y determinar su utilidad local.

Epidemiological characteristics of pediatric patients with COVID-19 in General Cabrera, Córdoba, Argentina, across 3 periods of the pandemic. / Caracterización epidemiológica de pacientes pediátricos con COVID-19 en General Cabrera, Córdoba, Argentina, durante tres períodos de la pandemia.

Introduction. The onset of the SARS-CoV-2 pandemic raised questions about its behavior in different scenarios. Objective. To describe the clinical and epidemiological behavior of COVID-19 in pediatric patients living in an agricultural-industrial city across 3 periods (2020 to 2022). Population and methods. Observational, analytical study of children under 18 years diagnosed with COVID-19 in General Cabrera. Sex, age, symptoms, comorbidities, hospitalization, and death were analyzed. The χ² test was used to analyze the association between symptoms and period and the KruskalWallis test, to analyze differences in symptom duration per period. Confidence level: 95%. Results. In the study period, 194 cases in children under 18 years were confirmed. Only 1% required hospitalization; no deaths were recorded. Children's median age was 14 years; 51% were boys; 68% were asymptomatic; 2% had associated comorbidities. Conclusion. SARS-CoV-2 infection was low in pediatrics and showed a distinct behavior by period.

Introducción. La aparición de la pandemia por SARS-CoV-2 generó grandes interrogantes sobre su comportamiento en diferentes escenarios. Objetivo. Describir el comportamiento clínico y epidemiológico de la COVID-19 en pacientes pediátricos residentes en una ciudad agroindustrial en tres períodos (2020 a 2022). Población y métodos. Estudio observacional, analítico de menores de 18 años con diagnóstico de COVID-19 en General Cabrera. Se evaluó sexo, edad, sintomatología, comorbilidades, internación y muerte. Se aplicó la prueba de chi-cuadrado para analizar la asociación entre sintomatología y período, y la prueba de Kruskal-Wallis para analizar diferencias en la duración de los síntomas por período. Nivel de confianza del 95 %. Resultados. En el período estudiado, se confirmaron 194 casos en menores de 18 años. Solo el 1 % requirió internación y no se registraron fallecimientos. El 51 % eran varones, con una mediana de edad 14 años para ambos sexos. El 68 % fue asintomático. Se detectaron comorbilidades asociadas en el 2 %. Conclusión. La infección por el SARS-CoV-2 tuvo baja presentación en pediatría, con comportamiento diferenciado según período.

Correction: Prevalence and factors associated with self-reported anxiety in adults during the COVID-19 pandemic in Argentina, Brazil, Peru, Mexico, and Spain: A cross-sectional Ibero-American study.

[This corrects the article DOI: 10.1371/journal.pone.0280528.].

[Lung injury associated with vaping: A case report]. / Lesión pulmonar asociada al vapeo: informe de un caso.

Vaping is the practice of inhaling an aerosol created by heating a liquid with an electronic cigarette. These aerosols contain toxic, carcinogenic compounds and nicotine, an addictive substance. In Argentina, the commercialization of electronic cigarettes is prohibited. Acute lung injury associated with vaping (EVALI) is an acute respiratory disease that can be life threatening. An 18-year-old male patient, smoker, consulted for shortness of breath and fever. He presented with hypoxemic respiratory failure, and leukocytosis. The patient reported use of electronic cigarettes. Chest computed tomography (CT) showed extensive areas of ground glass opacities with areas of consolidation with air bronchogram. Antibiotic treatment was started and a fibrobronchoscopy was performed, which showed hematic debris, without endoluminal lesions. A diagnosis of EVALI was done and high doses systemic corticosteroids were prescribed. The patient evolved favorably, hewas discharged 48 hours after the end of treatment. In the control ambulatory CT was observed an improvement of the lesions. EVALI is an exclusion diagnosis, so it is necessary to rule out infectious diseases and pulmonary inflammatory processes. There are different scores that describe the probability of EVALI. The Centers for Disease Control and Prevention (CDC), developed in 2019 a definition of confirmed case based on vape exposure, imaging, clinical presentation and history. In 2019 was first reported an EVALI in Argentina. It is important to know the criteria for a confirmed case to initiate accurate and early treatment, considering the exponential increase in electronic cigarette use, mainly in the young population.

El vapeo es la práctica de inhalar un aerosol creado al calentar un líquido con cigarrillo electrónico. Estos aerosoles contienen tóxicos, compuestos cancerígenos y nicotina, sustancia adictiva. En nuestro país está prohibida la comercialización del cigarrillo electrónico. La lesión pulmonar aguda asociada al vapeo (EVALI) es una enfermedad respiratoria aguda potencialmente mortal. Se presenta el caso de un varón de 18 años, tabaquista, que consultó por falta de aire y fiebre. Presentaba insuficiencia respiratoria hipoxémica y leucocitosis, refiriendo reciente inicio de utilización de cigarrillo electrónico. En la tomografía computarizada de tórax (TC) se observaban extensas áreas en "vidrio esmerilado" bilaterales y áreas de consolidación con broncograma aéreo. Se inició tratamiento antibiótico y se realizó una fibrobroncoscopia que mostró restos hemáticos sin lesiones endoluminales. Se interpretó como EVALI y se indicaron corticoides sistémicos. El paciente evolucionó favorablemente y egresó a las 48 h de finalizado el tratamiento. En TC de control se observó mejoría de las lesiones. El diagnóstico de EVALI es de exclusión. Existen diferentes scores que describen la probabilidad de un EVALI. Los Centers for Disease Control and Prevention (CDC), propusieron en 2019 una definición de caso confirmado de EVALI basado en la exposición al vapeo, las imágenes, la presentación clínica y los antecedentes. La primera notificación de un caso de EVALI en la Argentina fue en el año 2019. Es importante conocer los criterios diagnósticos para poder iniciar un tratamiento preciso y precoz, considerando el aumento exponencial del uso de cigarrillo electrónico, principalmente en la población joven.

Impact of COVID-19 on paracoccidioidomycosis. Which was the most influential: The pandemic or the virus?

The impact of COVID-19 on paracoccidioidomycosis (PCM) in Argentina and the consequences generated by the pandemic are discussed. From 2018 to 3 years after the pandemic declaration, 285 proven PCM patients were registered. No association between both diseases was documented. PCM frequency decreased to extremely low levels in 2020. Mandatory social isolation and the emotional and psychological effects generated under pandemic circumstances led to delays in diagnosis, severe disseminated cases, and other challenges for diagnosis in subsequent years. Probable underdiagnosis should be considered due to the overlap of clinical manifestations, the low index of suspicion and the lack of sensitive diagnostic tools.

Connected lives: Care, money management, and gender inequality in low-income households in times of crisis in Argentina.

Inspired by the sociology of Zelizer, this article lays out a framework of analysis that sheds light on money management as a cornerstone of the social organization of care. First, it lays out the features of the money management of care and caretaking practices to reveal a cyclical process in which the money side of care is rendered invisible and naturalized. It then turns to the question of debt, a key aspect of money management, and its reinforcement of gender inequalities during the care crisis associated with COVID-19. The findings are drawn from a qualitative survey of low-income households conducted in Argentina in 2021.

Inspiré par la sociologie de Zelizer, cet article propose un cadre d'analyse qui éclaire la gestion financière en tant que pierre angulaire de l'organisation sociale des soins. Il présente tout d'abord les caractéristiques de la gestion financière des soins et des pratiques de prise en charge afin de révéler un processus cyclique dans lequel l'aspect financier des soins est rendu invisible et naturalisé. Il aborde ensuite la question de la dette, un aspect clé de la gestion financière, et de son renforcement des inégalités de genre pendant la crise des soins associée au coronavirus. Les résultats sont tirés d'une enquête qualitative menée en Argentine en 2021 auprès de ménages à faibles revenus.

The impact of COVID-19 childhood and adolescent vaccination on mortality in Argentina.

INTRODUCTION: Argentina authorized COVID-19 vaccination for adolescents 12 years and older in August 2021, and then for children three years and older in October 2021. Children aged 6 months-2 years received a two-dose regimen beginning July 2022. OBJECTIVE: This study aims to analyze the impact of COVID-19 vaccination among children aged 0-17, considering vaccination status and mortality for the 2020-2022 period. METHODS: We conducted a population-level analysis examining all-cause mortality, COVID-19 cases, deaths, and vaccination records. We compared outcomes with child mortality for diseases for which vaccination is compulsory, before and after each vaccine rollout. RESULTS: A decrease in COVID-19-related deaths was observed in 2022 for pediatric age groups (3-11 and 12-17) with relatively higher vaccination coverage. However, no decrease was observed for the 0-2 year old age group, which had the longest delay in access to immunization and lowest vaccination coverage. When compared to unvaccinated populations in 2022, we observe an 8-15-fold reduction in cumulative death rates for pediatric populations vaccinated with 1 or more doses, and a 16-18-fold reduction for those vaccinated with 2 or more doses. Historical analysis shows that for diseases for which vaccination is now compulsory in many countries, pre-vaccine-rollout mortality was lower than COVID-19 deaths during 2020-2022. CONCLUSIONS AND RELEVANCE: SARS-CoV-2 immunization was associated with reduced COVID-19 deaths for children and adolescents in Argentina. Our findings suggest that greater efforts should be undertaken to ensure wider COVID-19 vaccine coverage in children and adolescents, especially infants.

Quality improvement collaborative for improving patient care delivery in Argentine public health sector intensive care units.

BACKGROUND: The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. OBJECTIVE: The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). METHODS: We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. RESULTS: We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. CONCLUSION: A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.

An Outbreak of SARS-CoV-2 in Captive Armadillos Associated with Gamma Variant in Argentina.

The current pandemic produced by SARS-CoV-2 and its variants represent an example of the one health concept in which humans and animals are components of the same epidemiologic chain. Animal reservoirs of these viruses are thus the focus of surveillance programs, to monitor their circulation and evolution in potentially new hosts and reservoirs. In this work, we report the detection of the SARS-CoV-2 Gamma variant infection in four specimens of Chaetophractus villosus (big hairy armadillo/armadillo peludo) in Argentina. In addition to the finding of a new wildlife species susceptible to SARS-CoV-2 infection, the identification of the Gamma variant three months after its last detection in humans in Argentina is a noteworthy result, which can be due to alternative non-exclusive scenarios, such as unidentified viral reservoirs, unrecognized circulation in humans or species-specific variation in incubation periods.

Mortalidad en pacientes hospitalizados por COVID-19 durante la primera ola en una institución de tercer nivel de Neuquén / Mortality in Patients Hospitalized for COVID-19 during the First Wave in a Tertiary Care Institution in Neuquén

Introducción: En diciembre de 2019, se detectó un brote de enfermedad por un nuevo coronavirus que evolucionó en pandemia con severa morbilidad respiratoria y mortali- dad. Los sistemas sanitarios debieron enfrentar una cantidad inesperada de pacientes con insuficiencia respiratoria. En Argentina, las medidas de cuarentena y control sani - tario retrasaron el primer pico de la pandemia y ofrecieron tiempo para preparar el sis- tema de salud con infraestructura, personal y protocolos basados en la mejor evidencia disponible en el momento. En una institución de tercer nivel de Neuquén, Argentina, se desarrolló un protocolo de atención para enfrentar la pandemia adaptado con la evo- lución de la mejor evidencia y evaluaciones periódicas de la mortalidad hospitalaria. Métodos: Estudio de cohorte observacional para evaluar la evolución de pacientes con COVID-19 con los protocolos asistenciales por la mortalidad hospitalaria global y al día 28 en la Clínica Pasteur de Neuquén en 2020. Resultados: Este informe describe los 501 pacientes diagnosticados hasta el 31 de di- ciembre de 2020. La mortalidad general fue del 16,6% (83/501) y del 12,2% (61/501) al día 28 de admisión. En los 139 (27,7%) pacientes con ventilación mecánica, la mortali- dad general y a los 28 días fue de 37,4% (52/139) y 28,1% (38/139) fallecieron, respec- tivamente. Los factores de riesgo identificados fueron edad, comorbilidades y altos re- querimientos de oxígeno al ingreso. Conclusión: La mortalidad observada en los pacientes hospitalizados en nuestra insti- tución en la primera ola de la pandemia COVID-19 fue similar a los informes internacio- nales y menor que la publicada en Argentina para el mismo período.

Introduction: In December 2019, an outbreak of disease due to a new coronavirus was detected that evolved into a pandemic with severe respiratory morbidity and mortality. Health systems had to face an unexpected number of patients with respiratory failure. In Argentina, quarantine and health control measures delayed the first peak of the pan - demic and offered time to prepare the health system with infrastructure, personnel and protocols based on the best evidence available at the time. In a third level institution of Neuquén, Argentina, a care protocol was developed to confront the pandemic adapted by evolving best evidence and periodic evaluations of hospital mortality. Methods: Observational cohort study to evaluate the evolution of patients hospitalized for COVID-19 with care protocols in terms of overall hospital mortality and at day 28 at the Pasteur Clinic in Neuquén in 2020. Results: This report describes the 501 patients diagnosed until December 31, 2020. Mortality was 16.6% (83/501) and 12.2% (61/501) on day 28 of admission. Among the 139 (27.7%) patients with mechanical ventilation, overall mortality and at 28 days it was 37.4% (52/139) and 28.1% (38/139), respectively. The risk factors identified were age, comorbidities and high oxygen requirements on admission. Conclusion: The mortality observed in patients hospitalized in our institution during the first wave of COVID-19 pandemic was similar to international reports and lower than other publications in Argentina for the same period.

Patrón de neumonía organizativa en TC de tórax: prevalencia y asociación con resultados clínicos en una cohorte de pacientes con COVID-19 grave/crítico / Organizing Pneumonia Pattern on Chest CT: Prevalence and Association with Clinical Outcomes in a Cohort of Patients with Severe/Critical COVID-19

Introducción: La neumonía por COVID-19 puede presentarse con dos patrones radio-lógicos: daño alveolar difuso o neumonía organizativa. Estos patrones tienen diferente evolución y pronóstico en pacientes sin infección por COVID-19. Nuestro objetivo fue evaluar la prevalencia del patrón radiológico de neumonía organizativa y su asociación con los desenlaces clínicos.Métodos: Se realizó un estudio de cohorte retrospectivo que incluyó a pacientes adultos hospitalizados por COVID-19 grave/crítica a los que se les realizó una tomografía computarizada de tórax en los 21 días posteriores al diagnóstico. Los patrones radiológicos fueron revisados y clasificados por dos radiólogos expertos. Resultados: De los 80 pacientes incluidos, el 89% (n=71) presentaron un patrón compatible con neumonía organizativa. Los principales hallazgos radiológicos fueron la distribución multilobar (98,7%) y bilateral (97,6%) con opacidades en vidrio esmerilado (97,6%). El 44% (n=33) de los sujetos requirió ingreso en cuidados intensivos, de los cuales el 24% (n=19) recibió ventilación mecánica. La presencia de neumonía organizativa se asoció de forma independiente con una disminución de las probabilidades de ventilación mecánica o muerte (Odds ratio 0,14; intervalo de confianza del 95%: 0,02 - 0,96; valor de p 0,045) en un modelo multivariado que incluía la edad, el sexo, el IMC y la afectación pulmonar en la TC.Conclusiones: Un patrón radiológico de neumonía organizativa es altamente prevalen-te en pacientes con COVID-19 grave/crítico y se asocia con mejores resultados clínico

Introduction: COVID-19 pneumonia can present with two distinct radiologic patterns: diffuse alveolar damage or organizing pneumonia. These patterns have been linked to different outcomes in non-COVID-19 settings. We sought to assess the prevalence of organizing pneumonia radiologic pattern and its association with clinical outcomes. Methods: We performed a retrospective cohort study including adult patients hospita- lized for severe/critical COVID-19 who underwent chest computed tomography within 21 days of diagnosis. Radiologic patterns were reviewed and classified by two expert radiologists. Results: Among 80 patients included, 89% (n=71) presented a pattern consistent with organizing pneumonia. The main radiologic findings were multilobar (98.7%) and bilateral (97.6%) distribution with ground glass opacities (97.6%). Intensive care admission was required for 44% (n=33) of subjects, of which 24% (n=19) received mechanical ventilation. The presence of organizing pneumonia was independently associated with a decreased odds of mechanical ventilation or death (Odds ratio 0.14; 95% confidence interval 0.02 - 0.96; p value 0.045) in a multivariate model including age, gender, BMI and lung involvement on CT. Conclusion: A radiologic pattern of organizing pneumonia is highly prevalent in patients with severe/critical COVID-19 and is associated with improved clinical outcomes.

Niños hospitalizados con influenza en un hospital pediátrico de Argentina durante 2019-2022: ¿qué ha cambiado luego de la pandemia por COVID-19? / Children with influenza admitted at a children's hospital in Argentina in the 2019­2022 period: What has changed after the COVID-19 pandemic?

Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infección respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.

Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019­2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.