Análisis de los dos primeros años de pandemia COVID-19 en un hospital de enfermedades infecciosas, en Buenos Aires / Analysis of the first two years of the COVID-19 pandemic in an infectious diseases hospital in Buenos Aires

Resumen Introducción: En el Hospital Muñiz se instauró la Unidad Febril (UF), un dispositivo que opera durante la pandemia por COVID-19. Su implementación ha demos trado la importancia de políticas públicas en el sistema sanitario, además del posible desarrollo de estrategias en vigilancia y seguimiento epidemiológico que den apor tes en salud. Se realizó un análisis de los dos primeros años en pandemia en la UF-Muñiz. El objetivo de esta unidad es determinar qué pacientes tienen criterios de mal pronóstico y definir la internación. Una de las características más importantes de esta UF es la atención de una población con enfermedades infectocontagiosas por ser este un Hospital dedicado a este tipo de patologías. Métodos: Se realizó un estudio observacional trans versal, retrospectivo, con el objetivo de evaluar las inter naciones realizadas en la UF-Muñiz durante el periodo comprendido entre enero 2020 y diciembre 2021. Resultados: Se recibieron 153 546 consultas, se in ternaron 2872 pacientes. En 2020 se internaron 1001 pacientes COVID-19 positivos (76%), 87 con tuberculosis (TBC) (6.6%) y 102 con HIV (7.7%). En 2021 se internaron 991 pacientes COVID-19 positivos (66%), 151 con TBC (10%) y 157 con HIV (10.5%) Conclusiones: Solo el 1.9% de las consultas deriva ron en internación y correspondieron en su mayoría a pacientes COVID-19 positivos, le siguieron casos de HIV y TBC en una menor proporción. La enfermedad pulmo nar obstructiva crónica (EPOC) y la obesidad fueron las comorbilidades que con mayor frecuencia requirieron internación en pacientes COVID-19.

Abstract Introduction: At the Muñiz Hospital, the Febrile Unit (UF) was established, a device that operates during the COVID-19 pandemic. Its implementation has demon strated the importance of public policies in the health system, in addition to the possible development of epi demiological surveillance and monitoring strategies that provide health contributions. An analysis of the first two years of the pandemic at UF-Muñiz was carried out. The objective of this unit is to determine which patients have poor prognostic criteria and define hospitalization. One of the most important characteristics of this UF is the care of a population with infectious diseases because this is a Hospital dedicated to this type of pathology. Methods: A retrospective, cross-sectional observa tional study was carried out with the objective of evalu ating the hospitalizations made at UF-Muñiz during the period between January 2020 and December 2021. Results: 153 546 consultations were received, 2872 patients were admitted. In 2020, 1001 COVID-19 positive patients (76%) were admitted, 87 with tuberculosis (TB) (6.6%) and 102 with HIV (7.7%). In 2021, 991 positive CO VID-19 patients (66%) were admitted, 151 with TB (10%) and 157 with HIV (10.5%) Conclusions: Only 1.9% of the consultations led to hospitalization, and the majority corresponded to CO VID-19 positives, followed by HIV and TB cases in a smaller proportion. Chronic obstructive pulmonary dis ease (COPD) and obesity were the comorbidities that most frequently required hospitalization in COVID-19 patients.

Viruela símica: vigilancia epidemiológica en la Unidad de Monitoreo Ambulatorio Muñiz, Buenos Aires / Monkeypox: epidemiological surveillance in the Muñiz Outpatient Monitoring Unit, Buenos Aires

Resumen Introducción: La viruela símica (VS) es una enfermedad viral zoonótica debida a un virus del género Orthopoxvirus, familia Poxviridae. En 1970 se detectó por primera vez en humanos en la República Democrática del Congo. Actualmente es endémica en África central y occidental. Puede presentarse con fiebre, malestar general, linfo-adenopatías dolorosas y exantema, y durar entre 2 y 4 semanas. Suele ser autolimitada, aunque se han descrito casos graves, principalmente en personas inmunocomprometidas, con una letalidad que varía entre 3% y 6% en países endémicos. Los objetivos de la vigilancia epidemiológica en los casos sospecho sos de VS son: describir las variables personales, tiempo y lugar de los casos notificados, realizar un rastreo y seguimiento de sus contactos, identificar brotes y realizar seguimiento clínico epidemiológico. Métodos: Se realizó un estudio de cohorte retrospectivo durante el 9 de junio al 15 de septiembre de 2022. Resultados: Se han atendido 82 pacientes con sintomatología compatible 56 casos fueron positivos y 26 negativos. De los 26 casos negativos, 7 casos (27%) correspondían a varicela, 4 caso s (15%) a sífilis y 2 casos (8%) a herpes zoster. Los primeros síntomas se iniciaron dos a cinco días previos a la consulta, siendo los más frecuentes fiebre, mialgia, astenia, cefalea y linfoadenopatía dolorosa. Conclusiones: La vigilancia epidemiológica de VS permite la detección de casos, el seguimiento continuo y sistemático de los contactos mediante un proceso integrado entre vigilancia y laboratorio, para generar información oportuna, válida y confiable, que permite orientar medidas de prevención y control.

Abstract Introduction: Monkeypox (SV) is a zoonotic viral disease. Monkeypox virus belongs to the Ortho poxvirus genus of the Poxviridae family. In 1970 it was detected for the first time in humans, in the Democratic Republic of the Congo. It is currently considered an endemic disease in central and western Africa. It can pres ent with fever, malaise, painful lymphadenopathy and rash, and last between 2 and 4 weeks. It is usually self-limited, although severe cases have been described, mainly in immunocompromised people, with lethality varies between 3% and 6% in endemic countries. The objectives of epidemiological surveillance in suspected cases of SV are: to describe the personal variables, time and place of the reported cases, to track and follow up their contacts, to identify outbreaks and perform clinical epidemiological follow-up. Methods: A retrospective cohort study was conducted from June 9 to September 15, 2022. Results: 82 patients with compatible symptoms have been treated, 56 cases were positive and 26 negative. Of the 26 negative cases, 7 cases (27%) corresponded to chickenpox, 4 cases (15%) to syphilis, and 2 cases (8%) to herpes zoster. Conclusions: The first symptoms began two to five days prior to consultation, the most frequent being fever, myalgia, asthenia, headache, and painful lymphadenopathy. Epidemiological surveillance of SV provides timely detection of cases, continuous and systematic follow-up of contacts through an integrated process between surveillance and laboratory, to generate timely, valid and reliable information, which allows guiding prevention and control measures.

La Unidad Febril de Urgencias del Hospital Muñiz frente a COVID-19, HIV y tuberculosis / The Febrile Emergency Unit at Muñiz Hospital facing COVID-19, HIV and tuberculosis

Resumen Para hacer frente a la pandemia causada por el SARS CoV-2, en la Ciudad Autónoma de Buenos Aires se establecieron Unidades Febriles de Urgencias anexas a los hospitales de alta compleji dad. Se realizó un estudio observacional y retrospectivo con el objeto de evaluar el perfil de las personas que consultaron durante el período comprendido entre las semanas epidemiológicas 28 y 42, 2020. Se recibieron 12 571 consultas, el promedio de edad fue 38.2 años y 6801 (54.1%) pacientes eran varones. Se realizaron 9501 hisopados (RT-PCR para SARS-CoV-2) y 2499 (26.3%) fueron confirmados positivos. La edad media de los confirmados para COVID-19 fue 37.9 años, 1367 (54.7%) eran varones y 143 (5.7%) requirieron internación en la primera consulta. Tantos como 6097 (48.5%) participantes contaban con obra social o medicina prepaga. Consultaron solo 160 pacientes con HIV, se diagnosticó coinfección HIV/COVID-19 en 39/160 (24.4%) infectados con HIV y requirieron internación 9/39 (23.1%) coinfectados. Consultaron 128 pacientes con tuberculosis (TB), se diagnosticó coinfección TB/COVID-19 en 31/128 (24.2%) y requirieron internación 8/31 (25.8%) coinfectados. La triple asociación HIV/TB/COVID-19 fue constatada en 2 pacientes. Contrariamente a lo esperado, las dos principales enfermedades atendidas en el hospital, TB y HIV, estuvieron poco representadas en la consulta, pero el requerimiento de internación para los coinfectados fue elevado. Esto puede deberse a consulta tardía por restricciones de movilidad y asistencia durante la cuarentena. Nuestros datos también indican que el sector público de la ciudad debió absorber demanda insatisfecha del sector privado.

Abstract Febrile Emergency Units were annexed to tertiary hospitals to face the pandemic caused by SARS CoV-2 in Buenos Aires City. We performed a retrospective observational study in order to evaluate the profile of people consulting the Unit annexed to the Muñiz Hospital, during the period comprising epidemiological weeks 28 to 42, 2020. The total number of consultations was 12 571; 6801 (54.1%) patients were male, and the average age was 38 years. A total of 2499 (26.3 %) of 9501 swabs resulted positive for SARS-CoV-2 when analyzed by RT-PCR. The average age of confirmed COVID-19 patients was 37.9 years; 1367 (54.7%) were male and 143 (5.7%) required hospitalization at the first consultation. As many as 6097 (48.5%) participants were beneficiaries of social security or prepaid medicine. Only 160 (1.3%) were HIV positive, with COVID-19 coinfection diagnosed in 39/160 (24.4%), of which 9 (23.1%) required hospitalization. Only 128 (1%) had tuberculosis (TB); TB/CO VID-19 coinfection was diagnosed in 31 of them (24.2%), and 8/31 (25.8%) required hospitalization. The triple association HIV/TB /COVID-19 was reported in only 2 patients. Contrary to expectations, TB and HIV, the two main diseases treated in our hospital, were under-represented in this Emergency Unit, but the requirement of hospitalization for coinfected patients was quite frequent. This may be due to late consultation caused by mobility and assistance restrictions during quarantine. Interestingly, our data also indicate that the city's public sector had to absorb unsatisfied demand from the private sector and suburban population.

Covid-19 en pacientes privados de libertad en una Unidad de Internación Penitenciaria / COVID-19 in patients deprived of liberty in a prision intation unit

El sistema carcelario debió incorporar medidas destinadas a la prevención, detección temprana, aislamiento y tratamiento de los pacientes con COVID-19. Se dispuso el Centro Penitenciario de Enfermedades Infecciosas-Unidad 21 como sitio de derivación. Se realizó un estudio descriptivo, observacional, transversal donde se describieron las características, tratamiento y evolución de los pacientes internados en dicha Unidad por COVID-19, en contexto de detención. En el período estudiado (01 de mayo-15 de octubre de 2020) se registraron 427 casos de COVID-19 en el Servicio Penitenciario Federal, de los cuales 193 fueron derivados a la Unidad 21. De ellos, 191 (98.9%) fueron de género masculino, con una mediana de edad de 51.5 (RI 32.5). Presentaron formas leves de la enfermedad 74 pacientes (38.3%), moderadas 110 (56.9%), graves 7 (3.6%). Requirieron Unidad de Terapia Intensiva 6 pacientes (3.1%) de los cuales 2 60 LA PRENSA MÉDICA ARGENTINA Covid-19 en pacientes privados de libertad en una Unidad de Internación Penitenciaria V.107/Nº 2 ingresaron en estado crítico a la Unidad y recibieron menos de 48hs de tratamiento en nuestro centro. Se produjeron 4 muertes, 2 por distrés respiratorio, 1 por accidente cerebrovascular de tronco encefálico y 1 muerte súbita. Según criterio de gravedad los pacientes recibieron tratamiento con ivermectina, corticosteroides, antibióticos, antiagregante y/o profilaxis antitrombótica. El 66.6% de los pacientes presentaron al menos una comorbilidad y el 22.8%, 2 o más. La letalidad por COVID-19 documentada fue del 2.07% en nuestro centro. Esto es relevante teniendo en cuenta los datos reportados de otras poblaciones penales, por ejemplo, de las cárceles estadounidenses donde la mortalidad era 5.5 veces más alta que en el resto de la población

The prison system had to incorporate measures aimed at the prevention, early detection, isolation and treatment of patients with COVID-19. The Penitentiary Center for Infectious Diseases-Unit 21 was set up as a referral site. A descriptive, observational, cross-sectional study was carried out in which the characteristics, treatment and evolution of patients admitted to the Unit for COVID-19, in the context of detention, were described. In the period studied (May 1-October 15, 2020), 427 cases of COVID-19 were registered in the Federal Penitentiary Service, of which 193 were referred to Unit 21. Of these, 191 (98.9%) were of Male gender, with a median age of 51.5 (RI 32.5). 74 patients (38.3%) had mild forms of the disease, 110 (56.9%) were moderate, 7 (3.6%) were severe. 6 patients (3.1%) required the Intensive Care Unit, of which 2 were admitted to the Unit in critical condition and received less than 48 hours of treatment in our center. There were 4 deaths, 2 from respiratory distress, 1 from brain stem stroke, and 1 sudden death. According to severity criteria, the patients received treatment with ivermectin, corticosteroids, antibiotics, antiaggregant and / or antithrombotic prophylaxis. 66.6% had at least one comorbidity and 22.8%, 2 or more. The documented COVID-19 fatality was 2.07% in our center. This is relevant considering the data reported from other prison populations, for example from American prisons where mortality was 5.5 times higher than in the rest of the population

Mejoria pronóstica de pacientes con tuberculosis multirresistente asociada a enfermedad por HIV/SIDA tratados con terapia antirretroviral de alta eficacia / Improved prognosis in HIV/AIDS related multi-drug resistant tuberculosis patients treated with highly active antiretroviral therapy

A prospective cohort study was carried out in patients assisted in the F. J. Muniz Infectious Disease Hospital, with the aim of determining the effectiveness of highly active antiretroviral therapy (HAART) implemented as soon as the sputum smear microscopy became negative (1 to 3 months) in the survival improvement of HIV/AIDS related multidrug-resistant tuberculosis patients. The cohort was recruited from June 1997 to February 1999 and compared with a pre-HAART control group that consisted of 43 patients. The follow-up of the patients was terminated June 2000. A total of 48 patients who received HAART precociously were included. The mortality rate in this group was 31.2 per cent and the survival time of deceased patients 15.8 +/- 8.5 months. The T lymphocytes CD4+ count was initially 40.1 +/- 30.2/microL, while at the end of the observation period it was 140.4 +/- 73.04/microL and 79.1 per cent of these patients presented undetectable viral load. In the control group the overall mortality was 90.7 per cent and the survival time of deceased patients 8.95 +/- 3.72 months. We conclude that the early anti-retroviral therapy, together with the treatment of the multidrug-resistant tuberculosis and of other AIDS associated diseases represent a useful approach to achieve a longer and better survival in these severely immunodepressed patients.