Rendimiento de los índices predictores de gravedad en pacientes adultos hospitalizados por neumonía adquirida en la comunidad por coronavirus SARS-CoV-2 / Performance of severity indexes for the prediction of adverse events among patients hospitalized for SARS-CoV-2

BACKGROUND: Severity assessment in adult patients with community-acquired pneumonia (CAP) allows to guide the site of care (ambulatory or hospitalization), diagnostic workup and treatment. AIM: To examine the performance of twelve severity predictive indexes (CRB65, CURB65, PSI, SCAP, SMART-COP, REA-ICU, ATS minor criteria, qSOFA, CALL, COVID GRAM, 4C, STSS) in adult patients hospitalized for CAP associated with SARS-CoV-2. MATERIAL AND METHODS: Prospective clinical study conducted between April 1 and September 30, 2020 in adult patients hospitalized for CAP associated with COVID-19 in a clinical hospital. The recorded adverse events were admission to the critical care unit, use of mechanical ventilation (MV), prolonged length of stay, and hospital mortality. The predictive rules were compared based on their sensitivity, specificity, predictive values, and area under the receiver operator characteristic (ROC) curve. RESULTS: Adverse events were more common and hospital stay longer in the high-risk categories of the different prognostic indices. CURB-65, PSI, SCAP, COVID GRAM, 4 C and STSS predicted the risk of death accurately. PSI, SCAP, ATS minor criteria, CALL and 4 C criteria were sensitive in predicting the risk of hospital mortality with high negative predictive value. The performance of different prognostic indices decreased significantly for the prediction of ICU admission, use of mechanical ventilation, and prolonged hospital length of stay. CONCLUSIONS: The performance of the prognostic indices differs significantly for the prediction of adverse events in immunocompetent adult patients hospitalized for community-acquired pneumonia associated with COVID-19.

Evaluación de los predictores clínicos de infección respiratoria aguda por coronavirus SARS-CoV-2 en población adulta / Clinical features of COVID-19 infection among patients consulting at an emergency service

Background: COVID-19 is a serious public health problem worldwide. Aim: To describe the clinical features of COVID-19 infection in adult patients consulting at an Emergency Service. Material and Methods: Descriptive prospective study of adult patients with suspected COVID-19 consulting between April 1 and July 31, 2020, at the Emergency Service of a clinical hospital. Clinical features, chronic comorbidities and demographic data were recorded. Results: We assessed 2,958 adult patients aged 42 ± 15 years (46% males). In 54% of them, COVID-19 infection was confirmed, 40% had preexisting diseases, especially hypertension (15%), hypothyroidism (6%), diabetes (6%), asthma (5%) and obesity (6%). The main clinical manifestations associated with COVID-19 were general malaise (79%), anorexia (38%), myalgia (64%), fever (52%), headache (70%), anosmia/dysgeusia (60%), cough (56%), dyspnea (54%) and diarrhea (36%). In the multivariate analysis, the main clinical predictors of COVID-19 infection were malaise, anorexia, fever, myalgia, headache, nasal congestion, cough, expectoration, anosmia/dysgeusia, and history of close contact with a SARS-CoV-2 patient. Odynophagia and chest discomfort were negative predictors of the disease. The history of fever associated with anorexia, cough, and dyspnea or anosmia/dysgeusia and close contact with a SARS-CoV-2 patient had high specificity and positive predictive value for COVID-19 infection. Conclusions: Clinical features of COVID-19 infection were highly unspecific in these patients. Clinical diagnostic prediction models could be useful to support healthcare decision making at primary care setting.

Transmisión del virus del dengue y su relación con factores climáticos durante los períodos intra e interepidémicos en Santo Domingo, República Dominican / Dengue Virus Transmission and its Relationship with Climatic Factors During Intra and Interepidemic Periodsin Santo Domingo, Dominican Republic

Introducción: Aedes spp. y la dinámica del virus del dengue está altamente influenciada por factores ambientales. Una relación detallada entre el clima y la enfermedad en los períodos inter e intra-epidémicos podrían beneficiar la vigilancia del dengue para optimizar la preparación y las políticas adecuadas de control de vectores. Métodos: se analizaron los informes de casos de dengue y las variables climáticas en Santo Domingo, República Dominicana, para determinar la correlación del período 2012- 2018 y los diferentes tiempos de retraso. Se llevó a cabo un análisis de regresión de dichas variables para comprender mejor las relaciones entre las tasas de incidencia del dengue y los cambios climáticos. Resultados: durante los brotes epidémicos, la temperatura (r = 0.73, p <0.001) y la humedad relativa (r = -0.2, p = 0.009) se correlacionan significativamente con la incidencia del dengue con un retraso de 9 semanas, el análisis de regresión muestra que la temperatura media (b = 62.401, p < 0.001), precipitación (b = 2.810, p <0.001) y humedad relativa (b = -5.462, p = 0.025) fueron predictores significativos. Durante los períodos inter-epidémico, la temperatura (r = 0.23, p <0.001) tuvo una correlación significativa con la incidencia del dengue con un retraso de 7 semanas, la humedad relativa (b = 1.454, p <0.05) y la temperatura media (b = 5.14, p <0.01) son predictores significativos de la cantidad de casos de dengue. La precipitación no se correlacionó significativamente con la incidencia del dengue. Conclusiones: existe una relación no lineal entre los factores climáticos y la incidencia del dengue. La infección por dengue depende del clima, y la temperatura parece jugar un papel importante en los factores climáticos.

Introduction: Aedes spp. and Dengue Virus dynamics are highly influenced by environmental factors. A detailed relationship between climate and disease in inter and intra-epidemic periods may benefit dengue surveillance, preparedness, and adequate vector control policies. Methods: Dengue case reports and climatic variables in Santo Domingo, Dominican Republic, were analyzed for climate variables correlation from the period 2012-2018 and varying lag times. Regression analysis of climatic variables was carried out to better understand significant correlations between dengue incidence rates and changes in climate. Results: During epidemic outbreaks, temperature (r = 0.73, p < 0.001) and relative humidity (r = -0.22, p = 0.009) demonstrated a significant correlation with dengue incidence. Our regression analysis demonstrates an increase 62.4 cases for each degree Celsius increased with a 9-week-lag. Regression analysis also demonstrated mean temperature (b= 62.401, p < 0.001), precipitation (b = 2.810, p < 0.001), and relative humidity (b = -5.462, p = 0.025) to be significant predictors. During inter-epidemic periods, temperature (r = 0.23, p < 0.001) had a significant correlation with dengue incidence with a 7-week-lag, which demonstrates that relative humidity (b = 1.454, p < 0.05), and mean temperature (b = 5.14, p < 0.01) are significant predictors of the quantity of dengue cases. Precipitation did not significantly correlate with dengue incidence. Conclusions: A non-linear relationship between climatic factors and dengue incidence exists in the Dominican Republic. Dengue infection is climate-dependent and temperature seems to play a significant role in climatic factors

Zuccagnia punctata Cav. Essential Oil into Poly(ε-caprolactone) Matrices as a Sustainable and Environmentally Friendly Strategy Biorepellent against Triatoma infestans (Klug) (Hemiptera, Reduviidae)

The main strategies against Triatoma infestans (primary vector responsible for the Chagas disease transmission) are the elimination or reduction of its abundance in homes through the application of insecticides or repellents with residual power, and environmental management through the improvement of housing. The use of plant-derived compounds as a source of therapeutic agents (i.e., essential oils from aromatic plants and their components) is a valuable alternative to conventional insecticides and repellents. Essential oil-based insect repellents are environmentally friendly and provide reliable personal protection against the bites of mosquitoes and other blood-sucking insects. This study investigates, for the first time to our knowledge, the potential repellent activity of Zuccagnia punctata essential oil (ZEO) and poly(ε-caprolactone) matrices loaded with ZEO (ZEOP) prepared by solvent casting. The analysis of its essential oil from aerial parts by GC­FID and GC-MS, MS allowed the identification of 25 constituents representing 99.5% of the composition. The main components of the oil were identified as (−)-5,6-dehydrocamphor (62.4%), alpha-pinene (9.1%), thuja-2, 4 (10)-diene (4.6%) and dihydroeugenol (4.5%). ZEOP matrices were homogeneous and opaque, with thickness of 800 ± 140 µm and encapsulation efficiency values above 98%. ZEO and ZEOP at the lowest dose (0.5% wt./wt., 96 h) showed a repellency of 33 and 73% respectively, while at the highest dose (1% wt./wt., 96 h) exhibited a repellent activity of 40 and 66 %, respectively. On the other hand, until 72 h, ZEO showed a strong repellent activity against T. infestans (88% repellency average; Class V) to both concentrations, compared with positive control N-N diethyl-3-methylbenzamide (DEET). The essential oils from the Andean flora have shown an excellent repellent activity, highlighting the repellent activity of Zuccagnia punctata. The effectiveness of ZEO was extended by its incorporation in polymeric systems and could have a potential home or peridomiciliary use, which might help prevent, or at least reduce, Chagas' disease transmission.

Manifestaciones clínicas y predictores de gravedad en pacientes adultos con infección respiratoria aguda por coronavirus SARS-CoV-2

Background: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan city and spread rapidly throughout China and the world. Aim: To describe the clinical features, risk factors, and predictors of hospitalization in adult patients treated for acute respiratory infections associated with coronavirus SARS-CoV-2. Material and Methods: Descriptive prospective study of ambulatory and hospitalized adult patients with confirmed COVID-19 attended between April 1 and May 31, 2020. Clinical features, chronic comorbidities and demographic data were recorded, and patients were followed for two months as outpatients. Results: We assessed 1,022 adults aged 41 ± 14 years (50% men) with laboratory-confirmed COVID-19. One-third had comorbidities, specially hypertension (12.5%), hypothyroidism (6.6%), asthma (5.4%) and diabetes (4.5%). Hospital admission was required in 11%, 5.2% were admitted to critical care unit and 0.9% were connected to mechanical ventilation. Common symptoms included fatigue (55.4%), fever (52.5%), headache (68.6%), anosmia/dysgeusia (53.2%), dry cough (53.4%), dyspnea (27.4%) and diarrhea (35.5%). One third of patients reported persistence of symptoms at one-month follow-up, specially fatigue, cough and dyspnea. In the multivariate analysis, age, fever, cough, dyspnea and immunosuppression were associated with hospitalization and ICU admission. Age, male sex and moderate-severe dyspnea were associated with requirement of mechanical ventilation. The main predictors of prolonged clinical course were female sex, presence of comorbidities, history of dyspnea, cough, myalgia and abdominal pain. Conclusions: Clinical features of COVID-19 were highly unspecific. Prediction models for severity, will help medical decision making at the primary care setting.

Rendimiento de los cuestionarios de sueño en la pesquisa de pacientes adultos con síndrome de apnea obstructiva del sueño según sexo / Gender differences in clinical features and performance of sleep questionnaires in adults with obstructive sleep apnea syndrome

Background: Women with obstructive sleep apnea-hypopnea syndrome (OSAS) are less likely to be assessed or to receive an appropriate diagnosis, and they may have poorer quality of life and survival rates. Aim: To assess gender-specific clinical differences in adult patients with OSAS. Material and Methods: A standardized clinical questionnaire and four sleep questionnaires (Berlin, Epworth Sleepiness Scale, STOP and STOP-Bang) were administered and anthropometric data were measured. Patients underwent an overnight in-laboratory polysomnography to confirm the diagnosis of OSAS. Receiver operating characteristic curves, sensitivity and specificity of clinical manifestations and sleep questionnaires were calculated. Results: Of 1,464 screened patients, 509 were female, 58.6% had moderate to severe OSAS. Clinical variables associated with OSAS risk in women were age, insomnia, nocturia, hypertension and cervical circumference. Paired by age and respiratory events, the snoring frequency was similar in both genders, although witnessed apneas and high cervical circumference and waist/hip ratio were more common in males. Morning headaches, insomnia, excessive daytime sleepiness, depression, anxiety and poor quality of sleep were more common in women. Women were older than men, more obese (although with an obesity pattern less centrally distributed) and referred hypertension, diabetes, depression and hypothyroidism with higher frequency. Sleep questionnaires performance were similar in both sexes. Conclusions: It is likely that women with OSAS may partially be underdiagnosed due to circumstances related to a different OSAS clinical expression.

Polychaetes from Burdwood Bank: "Namuncurá I" Marine Protected Area and slope, SW Atlantic Ocean

Introduction: The first open-sea (non-coastal) Marine Protected Area in Argentina, named "Namuncurá I" (NMPA), was created in 2013 at Burdwood Bank (BB), an undersea plateau located about 200 km south from Malvinas Islands (Falkland Islands) and 150 km east from Staten Island, SW Atlantic Ocean. It comprises three different management areas: the central one ("core", strict protection, only control and monitoring activities), surrounded by a "buffer" area (authorized activities, e.g. scientific research) and an external "transition" area (productive and extractive activities contemplated in the Management Plan). Beyond the transition area, only the southern shelf-break is protected, after the creation of the "Namuncurá II" MPA in December 2018. Objective: Provide the inventory of polychaetes collected during 2016 and 2017 at the core (98 m depth), buffer (128 m depth), transition (133 m-189 m depth) areas of the Namuncurá I MPA, together with slope areas (220 m-798 m depth). Methods: Taken with a trawl net used to characterize the faunal assemblages and to compare results with other Magellan areas. Multidimensional Scaling (MDS) and Cluster Analysis (CA) were applied to a Bray-Curtis similarity index to assess polychaete assemblages in the NMPA - BB slope and Magellan region respectively; SIMPER (Similarity Percentage Analyses) and ANOSIM (Analysis of Similarities) were performed. Results: A total of 918 individuals, which correspond to 39 taxa distributed in 22 families, were recorded in samples from NMPA and BB slope, mainly epibenthic or associated with the large corals collected. Ampharete kerguelensis McIntosh, 1885; Hyalinoecia artifex Verrill, 1880; Idanthyrsus macropaleus (Schmarda, 1861); Laetmonice producta Grube, 1877; Onuphis pseudoiridescens Averincev, 1972; Pista mirabilis McIntosh 1885 and Terebellides malvinensis Bremec & Elias, 1999 constitute new records for Burdwood Bank. A similar polychaete assemblage characterized the three areas of NMPA and slope locations, while H. artifex characterized locations at the NW deepest slope of the bank. Conclusions: These results indicate strong connections between the fauna collected at NMPA and the polychaetes assemblage in other Magellan areas dominated by soft bottoms. The biogeographic importance of the BB as connection for benthic polychaete species between South America and the Antarctic Peninsula merits future investigation.

Introducción: La primera Área Marina Protegida de mar abierto (no costera) en Argentina, llamada "Namuncurá I" (AMPN), fue creada en 2013 en el Banco Burdwood (BB), una plataforma sumergida ubicada unos 200 km al sur de las Islas Malvinas y 150 km al Este de la Isla de los Estados. En el Océano Atlántico SO. El área comprende tres diferentes áreas de manejo: la central ("el núcleo", con protección estricta, solo Control y actividades de monitoreo), rodeada por un área "de amortiguación" (solo actividades autorizadas, como investigación científica) y un área externa de "transición" (se contemplan actividades productivas y extractivas en el Plan de Manejo). Más allá del área de transición, el talud y las áreas adyacentes no presentan medidas de protección. Objetivos: Proporcionar un inventario de poliquetos colectados durante 2016 y 2017 en el Núcleo (98 m de profundidad), de Amortiguación (128 m), de Transición (133 m-189 m) y Talud (220 m-798 m). Métodos: Las muestras fueron obtenidas con una red de arrastre para caracterizar las asociaciones faunísticas y para compararlas con otras áreas Magallánicas. Análisis de Escalamiento Multidimensional y de agrupamiento aglomerativo jerárquico fueron aplicados a una matriz de similaridad de Bray-Curtis para determinar las asociaciones de poliquetos en el AMP - Talud del BB y región Magallánica, respectivamente. Resultados: Un total de 918 individuos, que corresponden a 39 taxones distribuidos en 22 familias, fueron registrados en las muestras del AMPN y talud del BB, mayormente epibentónicos o asociados a grandes corales. Ampharete kerguelensis McIntosh, 1885; Hyalinoecia artifex Verrill, 1880; Idanthyrsus macropaleus (Schmarda, 1861); Laetmonice producta Grube, 1877; Onuphis pseudoiridescens Averincev, 1972; Pista mirabilis McIntosh 1885 y Terebellides malvinensis Bremec & Elias, 1999 constituyen nuevos registros para el Banco Burdwood. Un ensamble de poliquetos similar caracteriza a las tres áreas del AMPN y talud, mientras que H. artifex caracteriza los sitios más profundos del talud del banco. Conclusiones: Estos resultados indican una fuerte conexión entre la fauna colectada en el NMPA y los ensambles de poliquetos de sustratos blandos de otras áreas Magallánicas. La importancia biogeográfica del BB como una conexión entre Sudamérica y la Península Antártica justifican futuras investigaciones.

Niveles socioeconómicos bajo y medio bajo comienzan a postergar la maternidad en Santiago de Chile / Delayed child bearing in a Chilean public hospital

Background: Postponement of motherhood is one of the most striking sociodemographic changes of modernity. Aim: To evaluate the age of primiparous women giving birth at a public hospital in Santiago, Chile. Material and Methods: Retrospective study, assessing the age and nationality of all women whose delivery occurred between 2009 and 2017 in a single hospital. Results: A total of 49,254 deliveries were registered: 43% were in primiparous women (73% Chilean and 27% foreign women). The proportion of foreign women increased from 12% in 2009 to more than 60% of total deliveries in 2017. Four percent of primiparous women were aged over 35 years of age and there was a steady increase in the age increase of primiparous women in the nine years of study. There was a higher proportion of normal-weight newborns among foreign women compared to their Chilean counterparts (86 and 81% respectively). Conclusions: In this sample of women attended at a public hospital, a steady increase in the age at first delivery was noted in a period of nine years. There was also a constant increase in the proportion of foreign women giving birth.