[Acute undifferentiated febrile illness among outpatients: differential diagnosis between dengue, zika, Argentine hemorrhagic fever and COVID-19]. / Síndrome febril agudo inespecífico en pacientes ambulatorios: diagnóstico diferencial entre dengue, zika, fiebre hemorrágica argentina y COVID-19.

The "acute undifferentiated febrile illness" (AUFI) encompasses a range of diseases characterized by the presence of fever, often prompting consultations in emergency services. During epidemics like COVID-19 or dengue, a surge in consultations occurs, resulting in long wait times for patients. Errors in first diagnosis can result in severe consequences. The objective is to provide a comprehensive review of the clinical approach to AUFI, focusing on certain viral infections (dengue, zika, Argentine hemorrhagic fever and COVID-19). This involves a detailed examination of the clinical presentation, laboratory and radiological findings, neurological manifestations, and definitive diagnosis through specific serological tests. AUFI is characterized by the onset of acute fever lasting less than seven days, accompanied by myalgia or headache without involvement of the upper respiratory tract and without a defined cause. Most cases are caused by common, self-limiting viral infections (e.g., influenza); however, they may also stem from more serious viral infections with a broad etiological spectrum. The differential diagnosis of acute febrile syndromes includes various infectious diseases, such as those previously mentioned. The definitive diagnosis is based on serological methods, PCR and IgM. Recommendations based on scientific evidence can help with early diagnosis and prevent possible serious complications.

El "síndrome febril agudo inespecífico" (SFAI) abarca una variedad de enfermedades que se distinguen por la presencia de fiebre, convirtiéndose en una causa común de consulta en los servicios de urgencias. Durante epidemias como la del COVID-19 o dengue (brote epidémico), se observa un aumento significativo de consultas con larga fila de pacientes esperando ser atendidos. Errores u omisiones en el diagnóstico inicial pueden acarrear graves consecuencias. El objetivo es ofrecer una revisión exhaustiva del enfoque clínico del SFAI, centrándose en determinadas infecciones virales (dengue, zika, fiebre hemorrágica argentina y COVID-19). Se examina detalladamente la presentación clínica, los hallazgos de laboratorio y radiológicos, las manifestaciones neurológicas y el diagnóstico definitivo mediante pruebas serológicas específicas. El SFAI se caracteriza por la aparición de fiebre aguda que dura menos de siete días, acompañada de mialgia o dolor de cabeza, sin afectación de las vías respiratorias superiores y sin una causa definida. La mayoría de los casos se deben a infecciones virales comunes, que suelen ser autolimitadas (ej. influenza); sin embargo, también pueden ser el resultado de infecciones virales más graves con un amplio espectro etiológico. El diagnóstico diferencial de los síndromes febriles agudos abarca diversas enfermedades infecciosas, como las mencionadas previamente. El diagnóstico definitivo se basa en métodos serológicos, PCR e IgM. Las recomendaciones basadas en evidencia científica pueden ayudar a un diagnóstico temprano y prevenir serias complicaciones.

[Epidemiological surveillance: review of data from the Febrile Unit of the Muñiz Hospital 2020-2024]. / Vigilancia epidemiológica: Revisión de datos de la Unidad Febril del Hospital Muñiz 2020-2024.

The appearance of epidemiological events that threaten the health system marked the importance of responses that go beyond the dissemination of information and since the COVID-19 pandemic, the Government of the City of Buenos Aires (Argentina) proposed an epidemiological surveillance model in devices called Febrile Units (UF). At the Muñiz Hospital, this unit provided epidemiological surveillance strategies in the pandemic and the different epidemics and outbreaks, still continuing its operation today. The objective of this work is to evaluate the implementation of the Febril Unit as an epidemiological surveillance structure. A review of the literature of epidemiological surveillance was carried out in the Febril Unit (UF) of the Muñiz hospital from 2020 to 2024, evaluating 3 elements of public health: diseases, risk factors, and other public health events. The search for epidemiological surveillance information generated 15 results in the final review, from which the following are described: diseases (COVID-19, monkeypox and dengue), associated risk factors (obesity and COPD in COVID-19, HIV,tuberculosis in COVID-19) and other public health events (tuberculosis, other respiratory viruses, burnout - emotional impact). The implementation of an epidemiological surveillance system together with a multidisciplinary team is important for public policies. The health data collected, analyzed and interpreted makes it possible to plan actions and develop strategies in epidemiological surveillance. The challenge is to find a response where the public health and epidemiological surveillance processes are not separated.

La aparición de eventos epidemiológicos que amenazan al sistema de salud marcó la importancia de respuestas que vayan más allá de la difusión de información. A partir de la pandemia por COVID-19 el Gobierno de la Ciudad de Buenos Aires (Argentina) planteó un modelo de vigilancia epidemiológica en las denominadas Unidades Febriles (UF). En el Hospital Muñiz la UF proporcionó estrategias de vigilancia epidemiológica en la pandemia y en otras epidemias y brotes, continuando en la actualidad su funcionamiento. El objetivo de este trabajo es evaluar la implementación de la UF como estructura de vigilancia epidemiológica. Se realizó una revisión de la literatura de la vigilancia epidemiológica en la UF del hospital Muñiz desde el 2020 al 2024, evaluando 3 elementos de la salud pública: enfermedades, factores de riesgo y otros eventos de salud pública. La búsqueda de información generó 15 resultados en la revisión final, desde donde se describen: enfermedades (COVID-19, viruela símica y dengue), factores de riesgo asociados (obesidad y EPOC en COVID-19, HIV, tuberculosis en COVID-19) y otros eventos de salud pública (tuberculosis, otros virus respiratorios, burnout - impacto emocional). La implementación de un sistema de vigilancia epidemiológica con un equipo multidisciplinario es importante para las políticas públicas. Los datos de salud recolectados, analizados e interpretados permiten planificar acciones y desarrollar estrategias de vigilancia epidemiológica. El desafío es buscar una respuesta donde los procesos de salud pública y vigilancia epidemiológica no estén separados.

[COVID-19 vaccine safety: results of active surveillance at a sentinel site in ArgentinaSegurança das vacinas contra COVID-19: resultados da vigilância ativa em uma unidade sentinela da Argentina]. / Seguridad de las vacunas contra la COVID-19: resultados de vigilancia activa en una unidad centinela en Argentina.

Objective: To analyze the results of surveillance of adverse events of special interest (AESI) within the context of the COVID-19 vaccination campaign at a sentinel site in Argentina. The retrospective (pre-vaccination) period was compared with the prospective (vaccination) period to identify safety signals. Methods: Retrospective and prospective search for AESI based on ICD-10 hospital discharge codes. A descriptive analysis, moving-averages trend smoothing, and control charts were used to detect changes in AESI behavior. Results: A total of 1,586 AESI were identified. Analysis of the proportion of AESI codes at hospital discharge revealed an increase during the pandemic period (2020) and a progressive decrease during the vaccination period (2021-2022), accounted for by the incidence of acute respiratory distress syndrome (ARDS). Moving-average smoothing and control charts were compared to identify time points at which the proportion of AESI exceeded the upper limits of control. During the vaccination period, this occurred for ARDS, thrombosis, myocarditis, meningoencephalitis, multisystem inflammatory syndrome, and anaphylaxis. No differences were observed for Guillain-Barré syndrome, thrombocytopenia, or pericarditis. Acute disseminated encephalomyelitis, meningoencephalitis, and pericarditis events during the vaccination period all occurred in subjects with no history of vaccination. Conclusion: Active sentinel-site surveillance allowed identification of AESI occurring at a higher frequency during the vaccination period compared to the pre-vaccination baseline. The protective effect of the vaccine against COVID -19 was clearly observed, as manifested especially by a reduction of ARDS cases in the post-vaccination period. This strategy is useful for assessing vaccine safety by identification of safety signals.

Objetivo: Analisar os resultados da vigilância de eventos adversos de interesse especial (EAIE) no contexto da campanha de vacinação contra a COVID-19 em uma unidade sentinela da Argentina; o período retrospectivo (pré-vacinação) foi comparado ao período prospectivo (vacinação) para identificar sinais de alerta. Método: Busca retrospectiva e prospectiva de EAIE com base nos códigos da Classificação Internacional de Doenças (CID-10) utilizados na alta hospitalar. Realizou-se uma análise descritiva, usando suavização da tendência por média móvel e cartas de controle para detectar mudanças no comportamento dos EAIE. Resultados: Foram identificados 1 586 EAIE. A análise da proporção baseada nas altas revelou aumento durante o período da pandemia (2020), com uma diminuição progressiva no período de vacinação (2021 e 2022) devido à síndrome do desconforto respiratório agudo (SDRA). A suavização por média móvel e as cartas de controle foram comparadas, destacando os momentos em que a proporção de EAIE excedeu os limites de controle superior. No período de vacinação, isso ocorreu em casos de SDRA, trombose, miocardite, meningoencefalite, síndrome inflamatória multissistêmica e anafilaxia. Não foram observadas diferenças na síndrome de Guillain-Barré, trombocitopenia e pericardite. Os eventos de encefalomielite disseminada aguda, meningoencefalite e pericardite no período de vacinação não tinham antecedentes associados às vacinas. Conclusão: A vigilância ativa na unidade sentinela permitiu identificar os EAIE mais frequentes no período de vacinação em comparação com a linha de base pré-vacinação. Também se observou o efeito protetor da vacina contra COVID-19, especialmente na diminuição dos casos de SDRA no período pós-vacinação. Essa estratégia é útil para avaliar a segurança das vacinas, identificando sinais de alerta.

Covid-19 and Diaguita communities: structural inequalities and (inter)community strategies in the Santa María department (Catamarca, Argentina). / Covid-19 y comunidades diaguitas: desigualdades estructurales y estrategias (inter)comunitarias en el departamento Santa María (Catamarca, Argentina).

The aim was to investigate and analyze the social, health, and economic impact of the Covid-19 pandemic on Indigenous communities in the province of Catamarca (Argentina), while also identifying the various strategies developed by these communities to address this phenomenon. The research was conducted between December 2021 and December 2022, with an exploratory nature and a predominantly qualitative methodological design. During the fieldwork, 15 in-depth interviews were conducted with community authorities, community members, territorial technicians, and health workers, complemented by 30 structured interviews with individuals from different communities in the Santa María Department. Although tensions between the official health system and Indigenous communities (with their worldviews and ancestral practices) are evident, the importance of community self-management and territorial control over Indigenous organizational processes is also observed in health prevention and care actions, as well as in establishing dialogues and negotiations with local health authorities regarding the implementation of measures in the territories.

El objetivo fue indagar y analizar el impacto social, sanitario y económico de la pandemia covid-19 en comunidades indígenas de la provincia de Catamarca (Argentina), buscando identificar también las diferentes estrategias construidas por parte de estas comunidades para hacer frente a este fenómeno. El trabajo de investigación se llevó a cabo entre diciembre de 2021 y diciembre de 2022, y ha tenido un carácter exploratorio y un diseño metodológico predominantemente cualitativo. Durante el trabajo de campo, se llevaron a cabo 15 entrevistas en profundidad a autoridades comunitarias, personas de la comunidad, técnicos territoriales y agentes de salud, las cuales fueron complementadas con 30 entrevistas estructuradas realizadas a personas de diferentes comunidades del departamento Santa María. Si bien se evidencia la existencia de tensiones entre el sistema de salud oficial y las comunidades indígenas (con sus cosmovisiones y sus prácticas ancestrales), también se observa la relevancia que ha asumido la autogestión comunitaria y el control territorial de los procesos organizativos indígenas en las acciones de prevención y atención de la salud, y en el establecimiento de diálogos y negociaciones con las autoridades del sistema de salud local respecto a la implementación de medidas en los territorios.

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

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.

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

Who Plays an Important Role for Information Networks of COVID-19 in Latin America?

This study highlights key players for COVID-19 in Brazil, Peru, Colombia, Chile, Argentina, and Ecuador by employing social network analysis for Twitter. This study finds that key players in Latin America play various roles in COVID-19 social networks, differing from country to country. For example, Brazil has no Latin key players, whereas Colombia and Ecuador have 8 Latin key players in the top 10 key players. Secondly, the role of governmental key players also varies across different countries. For instance, Peru, Chile, Argentina, and Ecuador have the governmental key player as the top key player, whereas Brazil and Colombia have the news media key player as the first. Thirdly, each country shows different social networks according to groups. For instance, Colombia exhibits the most open social networks among groups, whereas Brazil shows the most closed social networks among the 6 Latin countries. Fourthly, several top tweeters are common across the 6 Latin American countries. For example, Peru and Colombia have caraotadigital (Venezuelan news media), and Chile and Argentina have extravzla (Venezuelan news media) as the top tweeter.

Insights into Acinetobacter baumannii AMA205's Unprecedented Antibiotic Resistance.

The rise of antibiotic-resistant bacteria in clinical settings has become a significant global concern. Among these bacteria, Acinetobacter baumannii stands out due to its remarkable ability to acquire resistance genes and persist in hospital environments, leading to some of the most challenging infections. Horizontal gene transfer (HGT) plays a crucial role in the evolution of this pathogen. The A. baumannii AMA205 strain, belonging to sequence type ST79, was isolated from a COVID-19 patient in Argentina in 2021. This strain's antimicrobial resistance profile is notable as it harbors multiple resistance genes, some of which had not been previously described in this species. The AmpC family ß-lactamase blaCMY-6, commonly found in Enterobacterales, had never been detected in A. baumannii before. Furthermore, this is the first ST79 strain known to carry the carbapenemase blaNDM-1 gene. Other acquired resistance genes include the carbapenemase blaOXA-23, further complicating treatment. Susceptibility testing revealed high resistance to most antibiotic families, including cefiderocol, with significant contributions from blaCMY-6 and blaNDM-1 genes to the cephalosporin and carbapenem resistance profiles. The A. baumannii AMA205 genome also contains genetic traits coding for 111 potential virulence factors, such as the iron-uptake system and biofilm-associated proteins. This study underscores A. baumannii's ability to acquire multiple resistance genes and highlights the need for alternative therapies and effective antimicrobial stewardship to control the spread of these highly resistant strains.

Exploring the linkage between health technology assessment and decision making during COVID-19 public health emergency in a developing country: analysis of processes and results.

OBJECTIVES: The decision-making (DM) process in public administration is the subject of research from different perspectives and disciplines. Evidence-based policies, such as health technology assessment (HTA), are not the only support on which public policies are designed. During the COVID-19 pandemic WHO, national and subnational institutions developed HTA reports to guide DM. Despite this, inadequate variability was observed in the health technologies recommended and reimbursed by different provincial Health Ministries in a federally organized developing country like Argentina. The processes and results of DM on health technologies for COVID-19 in Health Ministries of Argentina were inquired. METHODS: A retrospective research design was developed, with triangulation of quantitative and qualitative methods. We retrieved information for the years 2020-2021 through document review of official webpages, surveys, and interviews with decision-makers of the 25 Argentinian Ministries of Health. We analyzed the recommendations and reimbursement policies of seven health technologies. RESULTS: In contradiction with WHO's policies, ivermectine, inhaled ibuprofen, convalescent plasma and equine serum were widely recommended by most of Argentina's health ministries outside a clinical trial context, with risks for patients and a huge opportunity cost. CONCLUSIONS: Despite an important HTA institutional capacity, the impact of HTA organizations and their technical reports was limited. Health Ministries with institutionalized HTA units had more adherence to WHO recommendations, but the influence of different technical and political criteria was identified. Power relations within and outside the administration, the pharmaceutical industry and academics, the media, social pressure, the judicial and legislative powers, and the political context strongly influenced DM.

Unveiling the silent information of wastewater-based epidemiology of SARS-CoV-2 at community and sanitary zone levels: experience in Córdoba City, Argentina.

The emergence of COVID-19 in 2020 significantly enhanced the application of wastewater monitoring for detecting SARS-CoV-2 circulation within communities. From October 2021 to October 2022, we collected 406 wastewater samples weekly from the Córdoba Central Pipeline Network (BG-WWTP) and six specific sewer manholes from sanitary zones (SZs). Following WHO guidelines, we processed samples and detected SARS-CoV-2 RNA and variants using real-time PCR. Monitoring at the SZ level allowed for the development of a viral activity flow map, pinpointing key areas of SARS-CoV-2 circulation and tracking its temporal spread and variant evolution. Our findings demonstrate that wastewater-based surveillance acts as a sensitive indicator of viral activity, detecting imminent increases in COVID-19 cases before they become evident in clinical data. This study highlights the effectiveness of targeted wastewater monitoring at both municipal and SZ levels in identifying viral hotspots and assessing community-wide circulation. Importantly, the data shows that environmental wastewater studies provide valuable insights into virus presence, independent of clinical COVID-19 case records, and offer a robust tool for adapting to future public health challenges.

Complications during extracorporeal membrane oxygenation transfer in Argentina: A multicenter observational study.

BACKGROUND: There is a lack of documented cases regarding complications during ECMO transfer in middle-income countries. Using portable ECMO devices facilitates patient transport but entails significantly higher costs, necessitating evidence of their practical utility. This study aims to describe complications during ECMO transfer in Argentina and to compare complication rates between the integrated portable ECMO and non-portable ECMO systems. METHODS: A multicenter observational retrospective study was conducted across four high-complexity hospitals in Argentina. Patients over 18 years old who underwent ECMO transfer between January 2017 and July 2023 were included. Complications were classified based on the Ericsson severity classification, a widely accepted system that categorizes complications based on their severity and the need for immediate organ support. The effect of the ECMO systems (portable and non-portable ECMO system) on complication rates was assessed using logistic regression weighted by inverse probability weighting (IPWT) analysis after propensity score assessment to adjust for confounders. RESULTS: The study included 65 patients who were transferred for ECMO. Complications occurred in 40% (95%CI: 28%, 52%; n=26) of transfers, with grade 2 complications being the most prevalent at 20% (95%CI 11%, 32%; n=13). Integrated portable ECMO systems were associated with fewer complications during ECMO transfer, showing a crude OR of 0.25 (95%CI 0.08, 0.75), and after adjustment by IPWT, an OR of 0.27 (95%CI 0.08, 0.93). CONCLUSIONS: ECMO transfers in middle-income countries exhibit complication rates similar to those in high-income countries. Our study found fewer complications in transfers using integrated portable ECMO systems and those involving distances exceeding 100 km. These findings suggest that the use of portable ECMO systems, despite their higher costs, may be beneficial in reducing complications during patient transport in middle-income countries.

Cognitive impact and brain structural changes in long COVID patients: a cross-sectional MRI study two years post infection in a cohort from Argentina.

OBJECTIVE: Long COVID is a condition characterised by persistent symptoms after a SARS-CoV-2 infection, with neurological manifestations being particularly frequent. Existing research suggests that long COVID patients not only report cognitive symptoms but also exhibit measurable cognitive impairment. Neuroimaging studies have identified structural alterations in brain regions linked to cognitive functions. However, most of these studies have focused on patients within months of their initial infection. This study aims to explore the longer-term cognitive effects and brain structural changes in long COVID patients, approximately two years post-infection, in a cohort from San Martín, Buenos Aires, Argentina. METHODS: We conducted a cross-sectional study involving 137 participants: 109 with long COVID symptoms and 28 healthy controls. The participants underwent an initial clinical assessment, completed a structured questionnaire and standardised scales, underwent a cognitive assessment, and had a brain MRI scan. Structural MRI images were processed via FreeSurfer and FSL to obtain volumetric measures for subcortical and cortical regions, along with regional cortical thickness. Differences between groups for these variables were analysed using ANCOVA, with permutation tests applied to correct for multiple comparisons. RESULTS: Long COVID patients reported persistent cognitive symptoms such as memory problems and brain fog, with higher levels of fatigue and reduced quality of life compared to controls. Despite subjective cognitive complaints, cognitive tests did not reveal significant differences between groups, except for the TMT-A (p = 0.05). MRI analysis revealed decreased volume in the cerebellum (p = 0.03), lingual gyrus (p = 0.04), and inferior parietal regions (p = 0.03), and reduced cortical thickness in several areas, including the left and right postcentral gyri (p = 0.02, p = 0.03) and precuneus (p = 0.01, p = 0.02). CONCLUSIONS: This study highlights the enduring impact of long COVID on quality of life and physical activity, with specific brain structural changes identified two years post-infection. Although cognitive tests did not show clear impairment, the observed brain atrophy and significant reduction in quality of life emphasize the need for comprehensive interventions and further longitudinal studies to understand the long-term effects of long COVID on cognition and brain health.

Pilgrimage to Luján in Argentina with Special Consideration to Argentines of Polish Descent During and After the COVID-19 Pandemic: The Spiritual Aspect.

Luján is considered the religious heart of Argentina, attracting pilgrims from all over the world. Among the pilgrimages across the world, there is also a Polish pilgrimage organized every year by Polish communities in Buenos Aires for the Polish Argentines. The purpose of this article is to examine the changes in the number of pilgrims, administered sacraments and celebrated masses in Luján from 2019 to 2023. The research shows that after a sharp decline in the number of pilgrims from 5 million in 2019 to 1 million in 2020 due to the COVID-19 pandemic, there has been a resurgence in pilgrimages, with over 6 million pilgrims worldwide in 2023. The article analyses empirical data collected through in-depth interviews with 25 Argentines of Polish descent (n = 25). Its purpose is to examine how the motives and intentions of these individuals for making a pilgrimage to Luján have changed before, during, and after the COVID-19 pandemic, as well as significance of the pilgrimage for each of them. The research clearly demonstrates that the pandemic has strengthened the faith of Polish pilgrims living in Argentina, who now view pilgrimages to Luján and entrusting their intentions to the Virgin Mary as a personal obligation.

Moral foundations messaging to improve vaccine attitudes: An online randomized experiment from Argentina.

The uptake of routine childhood vaccinations has declined globally since the start of the COVID-19 pandemic, due in part to increased vaccine hesitancy among parents. The Moral Foundations Theory proposes six foundations which can be targeted to increase vaccine uptake. In this study, we tested whether a post by UNICEF with a purity violation message could affect vaccine attitudes among parents in Argentina, where routine immunization coverage has been declining since 2014. Using an online randomized controlled survey experiment, we included 1,511 parents with a child under 12 years in Argentina. Outcomes were measured on the Vaccine Trust Indicator (VTI). We found that the purity violation message significantly affected vaccine attitudes: 80% of the intervention group scored high on the Vaccine Trust Indicator, compared to 73% in the control group (coefficient: 0.33, 95% Confidence Interval 0.20-0.47). Vaccine messaging framed as a purity violation is a promising way to improve vaccine attitudes among parents.

Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic.

This study evaluates the impact of the COVID-19 pandemic on healthcare workers in Argentina, during the second wave in 2021. The aim is to assess stress and burnout, incorporating the assessment of hair cortisol levels as a biomarker of chronic stress. A total of 496 healthcare workers from three different hospitals were included in this study. Two of these hospitals depend on the Buenos Aires City Ministry of Health and the third hospital belongs to Buenos Aires University. Hair samples were obtained using scissors from the posterior vertex, as close to the scalp as possible. Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method. Notably, 10% of the population exhibited hair cortisol levels above 128 pg/mg. Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization. In addition, burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support. Binary logistic regression revealed associations between burnout and perceived stress, and age. Finally, mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion. In conclusion, this study highlights the complex relationships between stress, cortisol levels, and burnout. Prioritizing interventions and research is essential to support the well-being of frontline healthcare professionals, ensuring their resilience during challenging times.

Estudio cualitativo sobre información, confianza y acceso a la vacunación contra COVID-19 en adolescentes en un centro de salud de Buenos Aires / Qualitative study on information, trust in and access to COVID-19 vaccines among adolescents at a healthcare center in Buenos Aires

Introducción. En la adolescencia, se comienzan a tomar decisiones autónomas sobre la salud. En la vacunación intervienen dimensiones contextuales, grupales y relativas a cada vacuna. Se busca conocer el proceso de información, confianza y decisión de vacunarse contra COVID-19 en adolescentes usuarios de un centro de salud en Buenos Aires. Objetivos. Identificar ámbitos y canales a través de los cuales los adolescentes accedieron a información sobre la vacuna contra COVID-19 en un centro de salud de Buenos Aires. Describir sus opiniones respecto a los distintos discursos sobre vacunación. Describir su participación en la vacunación contra COVID-19. Identificar barreras y facilitadores respecto del acceso a la vacunación contra COVID-19 en esta población. Población y métodos. Investigación cualitativa. Se hicieron entrevistas semiestructuradas a adolescentes usuarios del efector. La muestra fue heterogénea; su tamaño se definió por saturación teórica. Se realizó un análisis temático de los datos. Resultados. Se realizaron 14 entrevistas. Los entrevistados recibieron información sobre la vacuna contra COVID-19 de sus familias, la televisión y las redes sociales. Todos recibieron tanto publicidad oficial como discursos reticentes a la vacunación. Analizaron la información recibida y formaron opinión autónoma. Su decisión sobre vacunarse no siempre fue respetada. La desconfianza, la baja percepción del riesgo, el temor a las inyecciones, las barreras administrativas y geográficas fueron motivos de no vacunación. Conclusiones. Se requieren estrategias de comunicación destinadas a adolescentes que promuevan su participación en el acceso a la vacunación.

Introduction. During adolescence, individuals start to make autonomous decisions about their health. Vaccination involves contextual, group, and vaccine-specific dimensions. We sought to know the information, trust, and decision to receive the COVID-19 vaccine among adolescents who attended a healthcare center in Buenos Aires. Objectives. To identify settings and channels through which adolescents accessed information about the COVID-19 vaccine at a healthcare center in Buenos Aires. To describe their opinions about the different statements on vaccination. To describe their participation in COVID-19 vaccination. To identify barriers and facilitators to COVID-19 vaccination in this population. Population and methods. Qualitative study. Semi-structured interviews with adolescents who attended this healthcare facility. The sample was heterogeneous; the sample size was estimated by theoretical saturation. A thematic analysis of data was done. Results. A total of 14 interviews were conducted. Interviewees obtained information about the COVID-19 vaccine from their families, TV, and social media. All received information from both official campaigns and anti-vaccine communications. They analyzed the information they received and formed their own opinion. Their decision about the vaccine was not always respected. Hesitancy, a low perception of risk, fear of needles, administrative and geographic barriers were reasons for not receiving the vaccine. Conclusions. Communication strategies targeted at adolescents are required that encourage their involvement in access to vaccination.

An integrative analysis of SARS-CoV 2 during the first and second waves of COVID-19 in Salta, Argentina.

Wastewater surveillance has been extensively applied to provide information about SARS-CoV-2 circulation in the community. However, its applicability is limited in regions lacking adequate sewerage infrastructure, without wastewater treatment plants (WWTP) or with insufficient coverage. During the COVID-19 pandemic, from July 2020 to September 2021, comprehensive epidemiological data encompassing positive, recovered, and deceased cases were collected alongside precipitation records. Additionally, wastewater samples from 13 main sewersheds and river water from two points (up- and downstream the main WWTP), in the city of Salta, were gathered. A total of 452 water samples were analyzed for quantitative detection of SARS-CoV-2 using reverse transcription real-time PCR. Across the 62-week study period, two distinct waves of COVID-19 were identified. The dynamics of deceased cases showed peaks 10 and 28 days after the peaks of positive cases in the first and second waves, respectively. Downstream river water exhibited higher fecal contamination than the upstream samples, evincing the impact of the WWTP discharges. Viral concentration in river waters mirrored those from wastewater, reflecting the progression of cases. Despite the lower reported number of cases during the first wave in comparison to the second (5420 vs. 8516 cases at the respective peaks), higher viral concentrations were detected in water samples (1.97 × 107 vs. 2.36 × 106 gc/L, respectively), suggesting underreporting during the first wave, and highlighting the positive effect of vaccination during the second. To the best of our knowledge, this is the first study that simultaneously and systematically analyzed surface water and wastewater over a prolonged period, the effect of precipitations were considered for the variations in the concentrations, and the findings compared with epidemiological information. Environmental surveillance was demonstrated to be a great tool to obtain valuable information about the circulation patterns of SARS-CoV-2, especially under resource constraints to massively test the population, thus, underreporting cases. Furthermore, the methodology employed herein can be easily expanded to the community-level surveillance of other pathogens excreted in urine and feces, encompassing viruses, bacteria, and protozoa.

[Metabolic alterations observed in patients undergoing endocrinological follow-up during the first year of confinement due to Covid-19] / Alteraciones metabólicas observadas en pacientes en seguimiento clínico durante el primer año de confinamiento por Covid-19.

Introduction: At the beginning of the COVID-19 pandemic, confinement measures were applied in many states around the world, producing changes in lifestyle and health habits, whose metabolic impact was different in different populations. Objectives: Describe the metabolic and anthropometric changes in office patients in the City of Córdoba during the confinement period and determine possible associated factors. Methods: Retrospective analytical observational study based on the review of the medical records of patients seen in an endocrinology clinic in Córdoba, Argentina. They were followed up during the 1-year period by evaluating metabolic and anthropometric characteristics. Results: 149 patients were included, of which 116 (77.9%) were female and the median:IQR age was 50:36.5-58 years. At the end of follow-up, a significant increase in alcohol consumption (18.1% vs 11.4%, p=0.001) was observed, as well as the number of diabetic patients (diagnosis of 20 new cases). 49.67% of patients increased their body weight, with a median of 3.1 kg (IQR 25-75%: 1.4-7.5 kg). Patients who had longer follow-up (3 or more controls during the year) decreased their Body Mass Index and increased physical activity. Conclusions: Although confinement was generally associated with an increase in obesity, diabetes and consumption of toxic substances, in patients who were monitored more frequently, better control of body weight and increased activity was observed. physical.

Introducción: Al comienzo de la pandemia por COVID-19 se aplicaron medidas de confinamiento en muchas estados del mundo, produciendo cambios en los hábitos de vida y salud, cuyo impacto metabólico fue diferente en distintas poblaciones. Objetivos: Describir los cambios metabólicos y antropométricos en pacientes de consultorio en la Ciudad de Córdoba durante el período de confinamiento y determinar posibles factores asociados. Métodos: Estudio observacional retrospectivo analítico a partir de la revisión de las historias clínicas de pacientes atendidos en consultorio de endocrinología en Córdoba, Argentina. Se realizó el seguimiento de estos durante el período de 1 año evaluando características metabólicas y antropométricas. Métodos: Estudio observacional retrospectivo analítico a partir de la revisión de las historias clínicas de pacientes atendidos en consultorio de endocrinología en Córdoba, Argentina. Se realizó el seguimiento de estos durante el período de 1 año evaluando características metabólicas y antropométricas. Resultados: Se incluyeron 149 pacientes, de los cuales 116(77,9%) eran de sexo femenino y la mediana:RIC de edad fue 50:36,5-58 años. Al final del seguimiento se observó un aumento significativo del consumo de alcohol (18,1% vs 11,4%, p=0,001), así como también el número de pacientes diabéticos (diagnóstico de 20 nuevos casos). El 49,67% de los pacientes incrementó su peso corporal, con una mediana de 3,1Kg(RIC 25-75%: 1,4-7,5 kg). Los pacientes que tuvieron mayor seguimiento (3 o más controles durante el año), disminuyeron su Índice de masa corporal y aumento de actividad física. Conclusiones: Si bien el confinamiento se asoció en términos generales a un aumento del obesidad, diabetes y consumo de sustancias tóxicas, en los pacientes a los cuales se les realizó un seguimiento más frecuente, se observó mejor control del peso corporal y aumento de la actividad física.

[Implementation of new technologies in nutritional teleconsultation by Nutrition Graduates from Entre Ríos, Argentina] / Implementación de nuevas tecnologías en la teleconsulta nutricional por Licenciados en Nutrición de Entre Ríos, Argentina.

Introduction: The COVID-19 pandemic in Argentina has challenged health professionals to implement teleconsultation to maintain continuity of care. Objectives: Describe the implementation of new technologies in teleconsultation by Nutrition professionals from Entre Ríos, from the beginning of the ASPO to the new normal.Methodology: Observational, descriptive, quantitative, and cross-sectional study, in which 72 Nutrition professionals from Entre Ríos, Argentina participated through a self-administered online questionnaire. The descriptive analysis of the data was carried out in the IBM® SPSS Statistics program. Results: 84.7% of professionals began to implement new technologies in teleconsultation since the beginning of the ASPO. Although the majority did not experience significant changes in their income, relationships with patients, or time spent in teleconsultation compared to in-person care, 78% did not receive specific training for the implementation of these technologies in remote care. Despite this challenge, 80% expressed their intention to continue with this type of care in the new normal, allocating hours of their workload for this purpose. Conclusions: The implementation of new technologies in teleconsultation has proven to be an ally in maintaining the continuity of nutritional care since the beginning of ASPO. However, to provide a quality service, it is necessary to select the most appropriate technologies and dedicate sufficient time to planning and implementation.

Introducción: La pandemia de COVID-19 en Argentina ha desafiado a los profesionales de la salud a implementar la teleconsulta para mantener la continuidad de la atención. Objetivos: Describir la implementación de nuevas tecnologías en la teleconsulta por profesionales en Nutrición de Entre Ríos, desde el inicio del ASPO hasta la nueva normalidad. Metodología: Estudio observacional, descriptivo, cuantitativo y transversal, en el que participaron 72 profesionales en Nutrición de Entre Ríos, Argentina a través de un cuestionario en línea autoadministrado. El análisis descriptivo de los datos se realizó en el programa IBM® SPSS Statistics. Resultados: El 84,7% de los profesionales comenzó a implementar nuevas tecnologías en la teleconsulta desde el inicio del ASPO. Aunque la mayoría no experimentó cambios significativos en sus ingresos, la relación con los pacientes ni en el tiempo dedicado a la teleconsulta en comparación con la atención presencial, el 78% no recibió capacitación específica para la implementación de estas tecnologías en la atención remota. A pesar de este desafío, el 80% expresó su intención de continuar con esta modalidad de atención en la nueva normalidad, asignando horas de su carga horaria para este propósito. Conclusión: La implementación de nuevas tecnologías en la teleconsulta ha demostrado ser un aliado para mantener la continuidad de la atención nutricional desde el inicio del ASPO. Sin embargo, para brindar un servicio de calidad, es necesario seleccionar las tecnologías más apropiadas y de dedicar suficiente tiempo a la planificación e implementación.

Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves.

OBJECTIVE: To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina. METHODS: This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting-propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves. RESULTS: A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves). CONCLUSION: The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.

[Effect of previous exposure to COVID-19, occurrence of spikes, and type of vaccine on the humoral immune response of institutionalized older adults]. / Efecto de la exposición previa a COVID-19, ocurrencia de brotes y tipo de vacuna en la respuesta inmune humoral de adultos mayores institucionalizados.

This study evaluated the explanatory factors of humoral immune response in older adults admitted to long-term care institutions in Buenos Aires, Argentina, up to 180 days after vaccination. An open-label, prospective, multicenter cohort study was conducted with volunteers who received two doses of the Sputnik V, Sinopharm, or AZD1222 vaccines. Plasma samples were analyzed at 0 and 21 days after the first dose, 21 days after the second dose, and 120 and 180 days after the first dose. Marginal linear models and generalized additives mixed models were adjusted to determine the behavior of anti-spike IgG antibody concentration over time according to exposure group (naïve/no-naïve) and vaccine. Occurrence of an outbreak of COVID-19 in long-term care institutions and comorbidities were the covariates analyzed. A total of 773 participants were included, with a mean age of 83 years (IQR: 76-89). Results showed that antibody levels in the naïve: Sinopharm group were significantly lower to the other groups (p < 0.05). Antibody levels in the no-naïve: Sinopharm group were similar to those in the naïve group who received AZD1222 (p = 0.945) or Sputnik V (p = 1). Participants exposed to outbreaks in long-term care institutions had significantly higher antibody levels, regardless of exposure group and vaccine (p < 0.001). In conclusion, previous exposure to COVID-19, type of vaccine, and admittance into a long-term care institution with a history of outbreaks are factors to be considered in future epidemic events with transmission dynamics and immunological mechanisms similar to COVID-19, in populations similar to the one analyzed.

El objetivo de este trabajo fue evaluar los factores explicativos de la respuesta inmune humoral en adultos mayores de establecimientos de estancia prolongada de Buenos Aires, Argentina, hasta 180 días post vacunación. Se utilizó un diseño de cohorte abierta, prospectiva, multicéntrica, con voluntarios que recibieron dos dosis de vacunas Sputnik V, Sinopharm o AZD1222. Se analizaron muestras de plasma en los tiempos 0, 21 días post primera dosis, 21 días post segunda dosis, 120 y 180 días post primera dosis. Se ajustaron modelos lineales marginales y aditivos generalizados mixtos para evaluar el comportamiento de la concentración de anticuerpos IgG anti-Spike en el tiempo según grupo de exposición (naïve/no-naïve) y vacuna. Las covariables analizadas fueron: ocurrencia de brote de COVID-19 en establecimientos de estancia prolongada y comorbilidades. Se incluyeron en el análisis 773 participantes con una mediana de edad de 83 años (RIQ: 76-89). Al final del estudio, los niveles de anticuerpos del grupo naïve: Sinopharm fueron significativamente menores que el resto de los grupos (p < 0,05); los del no-naïve: Sinopharm resultaron similares a los naïve que recibieron AZD1222 (p = 0,945) o Sputnik V (p = 1). Los participantes expuestos a brotes en establecimientos de estancia prolongada presentaron niveles de anticuerpos significativamente mayores, independientemente del grupo de exposición y la vacuna (p < 0,001). Concluimos que la exposición previa a COVID-19, el tipo de vacuna y la pertenencia a un establecimiento de estancia prolongada con antecedente de brote son factores a considerar frente a futuros eventos epidémicos con dinámicas de transmisión y mecanismos inmunológicos similares al COVID-19, en poblaciones similares a la analizada en este trabajo.

Este estudo teve como objetivo avaliar os fatores explicativos da resposta imune humoral em idosos em instituições de longa permanência em Buenos Aires, Argentina, até 180 dias após a vacinação. Foi realizado um estudo de coorte aberto, prospectivo e multicêntrico, com voluntários que receberam duas doses das vacinas Sputnik V, Sinopharm ou AZD1222. As amostras de plasma foram analisadas nos tempos 0, 21 dias após a primeira dose, 21 dias após a segunda dose, 120 e 180 dias após a primeira dose. Os modelos lineares marginais e os aditivos generalizados mistos foram ajustados para determinar o comportamento da concentração de anticorpos IgG anti-Spike ao longo do tempo de acordo com o grupo de exposição (naïve/no-naïve) e vacina. As covariáveis analisadas foram ocorrência de pico de COVID-19 nas instituições de longa permanência e comorbidades. Foram incluídos 773 participantes, com média de idade de 83 anos (IIQ: 76-89). Os resultados apontaram níveis de anticorpos do grupo naïve: Sinopharm significativamente mais baixos do que os outros grupos (p < 0,05); e as variáveis do grupo no-naïve: Sinopharm foram semelhantes à do grupo naïve que recebeu AZD1222 (p = 0,945) ou Sputnik V (p = 1). Os participantes expostos a picos nas instituições de longa permanência apresentaram níveis de anticorpos significativamente maiores, independentemente do grupo de exposição e da vacina (p < 0,001). Conclui-se que a exposição prévia à COVID-19, tipo de vacina e adesão a uma instituição de longa permanência com histórico de pico são fatores a serem considerados em futuros eventos epidêmicos com dinâmica de transmissão e mecanismos imunológicos semelhantes à COVID-19, em populações semelhantes à analisada neste trabalho.