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Resumen Introducción: La información sobre COVID en médicos es limitada. Su conocimiento permitiría implementar acciones para reducir su impacto. El objetivo general fue determinar la incidencia de infección por SARS-CoV-2 en médicos de instituciones de salud de Argentina, sus características y factores aso ciados. Materiales y Métodos: Se realizó un estudio multicéntrico de cohorte prospectiva/retrospectiva con estudio de casos-controles anidado. Se incluyeron médicos activos al inicio de la pandemia no exceptuados por riesgo. Se estimó incidencia de casos confirmados. Se compararon factores asociados en casos y controles y se creó un modelo de regresión logística con las variables significativas del análisis bivariado. Resultados: Se incluyeron 343 médicos con COVID de 8 centros. La incidencia de la enfermedad fue de 12.1% y la de ausentismo global relacionado a COVID, de 34.1%. El 70% de los contactos estrechos fueron laborales. En el análisis multivariado de casos y controles, la residencia en la Ciudad Autónoma de Buenos Aires (OR 0.19, p = 0.01), el trabajo en áreas de alto riesgo (OR 0.22, p = 0.01) y vehículo individual (OR 0.34, p = 0.03) redujeron el riesgo de COVID. El odds de enfermar aumentó 4.6 veces (p = 0.02) por cada aislamiento por contacto estrecho. Discusión: El riesgo de enfermar aumentó considerablemente con cada aislamiento por contacto estrecho. La residencia en Ciudad Autónoma, el traslado en vehículo individual y el trabajo en áreas de alto riesgo lo redujeron. Dada la alta frecuencia de contactos estrechos en el ámbito laboral recomendamos reforzar las medidas de prevención en áreas de descanso y no COVID.
Abstract Background: Information about COVID infection in physicians is limited. This knowledge would allow the implementation of actions to reduce its impact. The objective was determining the incidence of SARS-CoV-2 infection in physicians from health institutions in Argentina, its characteristics, and associated factors. Methods: We conducted a multicenter prospective / retrospective cohort study with nested case-control study. Physicians active at the beginning of the pandemic were included, those on leave due to risk factors were excluded. The incidence of confirmed cases was estimated. We conducted bivariate analyses with various factors and used those significant in a logistic regression. Results: Three hundred and forty three physicians with COVID-infection from 8 centers were included. The incidence of disease was 12.1% and that of global absenteeism related to COVID, 34.1%. Almost 70% of close contacts were work-related. In the multivariate analysis living in Autonomous City of Buenos Aires (CABA) (OR 0.19, p = 0.01), working in high-risk areas (OR 0.22, p = 0.01) and individual transportation (OR 0, 34, p = 0.03) reduced the risk of COVID. The odds of infection increased 5.6 times (p = 0.02) for each close contact isolation. Discussion: The number of close contact isolation increased considerably the risk of infection. Living in Buenos Aires City, individual transpor tation and working in high-risk areas reduced it. Given the high frequency of close contact in the workplace, we strongly recommend the reinforcement of prevention measures in rest areas and non-COVID-wards.
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Abstract Objective: To estimate the frequency of lipid-poor adenomas (LPAs) in magnetic resonance imaging (MRI) examinations. Materials and Methods: We retrospectively investigated adrenal lesions on MRI examinations performed in a total of 2,014 patients between January 2016 and December 2017. After exclusions, the sample comprised 69 patients with 74 proven adenomas. Two readers (reader 1 and reader 2) evaluated lesion size, laterality, homogeneity, signal drop on out-of-phase (OP) images, and the signal intensity index (SII). An LPA was defined as a lesion with no signal drop on OP images and an SII < 16.5%. For 68 lesions, computed tomography (CT) scans (obtained within one year of the MRI) were also reviewed. Results: Of the 69 patients evaluated, 42 (60.8%) were women and 27 (39.2%) were men. The mean age was 59.2 ± 14.1 years. Among the 74 confirmed adrenal adenomas evaluated, the mean lesion size was 18.5 ± 7.7 mm (range, 7.0-56.0 mm) for reader 1 and 21.0 ± 8.3 mm (range, 7.0-55.0 mm) for reader 2 (p = 0.055). On the basis of the signal drop in OP MRI sequences, both readers identified five (6.8%) of the 74 lesions as being LPAs. When determined on the basis of the SII, that frequency was three (4.0%) for reader 1 and four (5.4%) for reader 2. On CT, 21 (30.8%) of the 68 lesions evaluated were classified as LPAs. Conclusion: The prevalence of LPA was significantly lower on MRI than on CT. That prevalence tends to be even lower when the definition of LPA relies on a quantitative analysis rather than on a qualitative (visual) analysis.
Resumo Objetivo: Estimar a frequência de adenomas pobres em lipídios (APLs) em exames de ressonância magnética (RM). Materiais e Métodos: Investigaram-se, retrospectivamente, as lesões adrenais em exames de RM realizados de janeiro de 2016 a dezembro de 2017. Um total de 2.014 pacientes foi submetido a exames abdominais e, após exclusões, 69 pacientes com 74 adenomas foram recuperados. Determinaram-se o tamanho da lesão, a lateralidade, a homogeneidade, a queda do sinal em imagens fora-de-fase (FF) e o índice de intensidade do sinal (IIS). Foram utilizadas as seguintes definições para APLs: sem queda de sinal nas imagens FF e IIS < 16,5%. Para 68 lesões, havia imagens de tomografia computadorizada (TC), com intervalo de até um ano da RM, que também foram analisadas. Resultados: Sessenta e nove pacientes foram incluídos, sendo 42 mulheres (60,8%) e 27 homens (39,2%). A média de idade foi 59,2 ± 14,1 anos. O tamanho médio do adenoma adrenal foi 18,5 ± 7,7 mm para o leitor 1 (7,0-56,0 mm) e 21,0 ± 8,3 mm (7,0-55,0 mm) para o leitor 2 (p = 0,055). A queda de sinal nas imagens FF mostrou que a frequência de APLs para ambos os leitores foi 6,8% (5/74). Para a análise quantitativa, a frequência foi 4,0% (3/74) para o leitor 1 e 5,4% (4/74) para o leitor 2. A frequência de APLs nas imagens de TC foi 21/68 lesões (30,8%). Conclusão: A prevalência de APLs em imagens de RM foi significativamente menor do que em exames de TC. Essa prevalência tende a ser ainda menor quando a definição de APL é baseada na análise quantitativa (IIS < 16,5%), em vez da análise visual.
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Introduction: Despite advances in perioperative management, acute pain and postoperative nausea and vomitingcontinue to be significant complications worldwide. The frequency and the implications of these complications for the process of recovery impact clinical findings, patient quality of care, and hospital costs. Materials and methods: A search and systematic review of the literature after 2011 was conducted. Three international guidelines were selected and they were paired-rated for quality using the AGREE II tool. Management recommendations, adjusted to the Colombian setting, were adopted on the basis of expert consensus, using the Delphi methodology. Results: Recommendations were generated for adult patients based on the international pain management guidelines for acute pain, postoperative nausea and vomiting, and transfer of critically ill patients. Some of the recommendations are of general nature while others are specific forparticular situations. They were all adapted to the Colombian context, bearing in mind the use of drugs which have not received approval from the healthcare authorities or which are not included in the Mandatory Healthcare Plan. Conclusions: Updating and standardizing clinical management recommendations based on the literature on international guidelines is a useful process, provided it is adapted to the national context. This process and its outcome may be useful for healthcare providers and has a positive effect on patient safety, practitioner performance and efficient use of resources.
Introducción: A pesar de los avances en el manejo perioperatorio, el dolor agudo y las náuseas y vómito posoperatorio aún son importantes complicaciones a nivel mundial. Su frecuencia de presentación y el grado de afectación en el proceso de recuperación impactan aspectos clínicos, la calidad de la atención de los pacientes y los costos hospitalarios. Materiales y métodos: Se realizó búsqueda y revisión sistemática de la literatura a partir de 2011. Se seleccionaron tres guías internacionales y se calificó la calidad de manera pareada con el instrumento AGREE II. Mediante consenso de expertos y utilizando metodología Delphi, se adaptaron las recomendaciones de manejo adaptadas al medio colombiano. Resultados: Se generaron recomendaciones para pacientes adultos extraídas de las guías de manejo internacional de dolor agudo, náuseas y vómito posoperatorio y transporte de paciente complicado. Algunas de las recomendaciones son generales y otras especificas para situaciones particulares. Todas fueron adaptadas al contexto colombiano teniendo en cuenta medicamentos que no cuentan con registro sanitario o no están incluidos en el Plan Obligatorio de Salud. Conclusiones: La actualización y estandarización de recomendaciones de manejo clínico basadas en la literatura de guías internacionales es un proceso útil siempre y cuando se adapte al contexto nacional. Este proceso y su resultado puede ser utilizado por prestadores de salud e impactar positivamente la seguridad del paciente, el desempeño de los profesionales sanitarios y la eficiencia de los recursos.
Subject(s)
HumansABSTRACT
El presente trabajo tuvo por objeto determinar el período de supervivencia en sedimentos marinos de bacterias con riesgo biológico o indicadoras. Se tomaron muestras de sedimento marino intermareal en dos playas de la ciudad de Comodoro Rivadavia, Argentina; una sometida a contaminación por efluentes domiciliarios, y otra sin pruebas de contaminación evidente. Sobre éstos se realizó una caracterización inicial por recuento de bacterias en diferentes medios de cultivo (TSA, VRB, VRBG, TCBS, agar bilis esculina y agar cetrimide) y por su identificación. También se realizó un estudio de supervivencia de los microorganismos de interés en microcosmos. Estos fueron monitoreados por conteo de bacterias y por identificación de los integrantes de interés. Los principales resultados indicaron que existe una marcada diferencia en la composición de la comunidad bacteriana entre ambas muestras. Los géneros bacterianos en la muestra contaminada fueron Aeromonas, Salmonella, Pseudomonas, Escherichia, Ochrobactum y Klebsiella, y en la playa no contaminada Bacillus, Paenibacillus, Micrococcus, Photobacterium y Vibrio. El ensayo en microcosmos demostró que, luego de 65 días, la comunidad bacteriana de la playa contaminada fue similar a la del sedimento sin contaminación, indicando que al retirar la fuente de contaminación, es probable la recuperación de la zona afectada.
The present study had the purpose of determining the survival period of bacteria which represent a biological risk and are indicators of contamination. Inter-tide marine sediment samples were taken at two beaches of the Comodoro Rivadavia city in Argentine; one the beaches was submitted to contamination due to household effluents, and the other without proof of evident contamination. These samples were initially characterized by bacterial counts in different culture media (TSA, VRB, TCBS, bile esculin agar and cetrimide agar) and by their identification. A study of the survival of the target bacteria in microcosm was also done, monitored by bacterial counts and identification of these bacteria. The main results indicated that there was a marked difference in the composition of the bacterial community between the two samples. In the contaminated sample the bacterial genus were Aeromonas, Salmonella, Pseudomonas, Escherichia, Ochrobactum and Klebsiella, and in the non-contaminated beach Bacillus, Paenibacillus, Micrococcus, Photobacterium and Vibrio. The microcosm assay showed that after 65 days the bacterial community of the contaminated beach was similar to that of the non-contaminated beach sediment, indicating that by withdrawing the contamination source, the affected zone can probably be recovered.
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Introducción: la vitrificación es una técnica de criopreservación de las denominadas "rápidas". En comparación con los tradicionales procesos de congelación lenta, la estrategia de vitrificación permite la eliminación total de la formación de cristales tanto intracelular como extracelularmente. Permite poner las células directamente en el crioprotector y sumergirlas en N2 líquido. Su aplicación en el mundo ha ido creciendo exponencialmente y se puede aplicar tanto a ovocitos como a embriones en cualquier estadio. Objetivos: revisión de la técnica de vitrificación y presentación de la experiencia de dos años en el Centro Iberoamericano de Reproducción Asistida, la primera en Uruguay. Material y método: se incluyeron 17 pacientes de las que se han vitrificado y desvitrificado embriones. Se usó el método comercial Cryotop con las soluciones de vitrificación de Kitazato. Resultados: con una media de embriones vitrificados de 2,71 (±0,69) por paciente, la tasa de supervivencia global de los embriones tras la desvitrificación fue de 93,4%. Con una media deembriones transferidos de 2,41 ±0,62), la tasa final de embarazo fue de 47,1%. La edad de las pacientes en las que se logra embarazo es menor (media 30,0 ±2,51) que las que no lo logran.Conclusiones: la vitrificación como método de criopreservación se muestra prometedor y como buen sustituto de las técnicas de congelación lentas, debido a su alta tasa de éxito, su fiabilidad y la rapidez de ejecución, con resultados reproducibles.
Introduction: vitrification is a cryopreservation technique that forms part of the so called "fast" cryopreservation techniques. Compared to traditional slow freezing processes, vitrification enables the total elimination of both intracellular and extracellular crystal formation. It allows for placing the cells directly on the cryoprotector and submersing them in liquid nitrogen. Its application around the world has exponentially grown and the technique may be applied both to ovocytes and embryos at all stages. Objectives: to carry out a review of the vitrification technique, the first one to be conducted in Uruguay, and to present the two-year experience at the Ibero-American Center for Assisted Reproduction. Method: we included 17 patients in our study, the embryos of which have been vitrified and unvitrified. We used the commercial Cryotop method with the Kitazato vitrification solutions. Results: with an average of 2,71 (±0,69) vitrified embryos per patients, global embryo survival rate after vitrification was 93,4%. With an average of 2,41 (±0,62) embryos transferred , the final pregnancy rate was 47,1%. The average age of patients who succeeded in getting pregnant is lower (average 30,0 ±2,51) than those who fail to get pregnant. Conclusions: vitrification as a cryopreservation method appears to be a promising technique and seems to be a good substitute for show freezing technique, due to its high-success rates, its reliability and execution speed, with replicable results.
Introdução: a vitrificação é uma técnica de criopreservação do grupo das chamadas técnicas "rápidas". Comparada com os processos tradicionais de congelação lenta, a vitrificação permite eliminar totalmente a formação de cristais tanto intra como extracelulares. Permite também colocar as células diretamente no crioprotetor e submergi-las em N2 líquido. Em todo o mundo sua aplicação vem crescendo exponencialmente e pode ser utilizada tanto com ovócitos como a embriões em qualquer estágio. Objetivos: revisão da técnica de vitrificação e apresentação da experiência de dois anos no Centro Iberoamericano de Reprodução Assistida, a primeira no Uruguay. Material e método: foram incluídas 17 pacientes que cujos embriões haviam sido vitrificados e desvitrificados. O método comercial Cryotop com soluções de vitrificação de Kitazato foi utilizado. Resultados: A média de embriões vitrificados foi de 2,71 (±0,69) por paciente com uma taxa de sobrevivência global dos embriões depois da desvitrificação de 93,4%. Com uma média de embriões transferidos de 2,41 (±0,62), a taxa final de gravidez foi de 47,1%. A idade das pacientes que engravidaram (média 30,0 ±2,51) era menor que a das que não engravidaram. Conclusões: a vitrificação se apresenta como um método de criopreservação prometedor e um bom substituto das técnicas de congelação lenta devido às altas taxas de sucesso, sua confiabilidade e rapidez para sua execução, com resultados reproduzíveis.
Subject(s)
Cryopreservation/methods , Cryopreservation/trendsABSTRACT
OBJETIVO: Determinar el papel de la tuberculosis bovina en la tuberculosis humana. MATERIAL Y MÉTODOS: Se analizaron 255 muestras de pacientes sintomáticos, sembradas en medios de Stonebrink y Lõwenstein-Jensen y analizadas por PCRMPB70 anidada y luego por spoligotyping. RESULTADOS: De las 255 muestras, 74 fueron positivas a la PCR y 20 al aislamiento: de las primeras, 58 (78 por ciento) mostraron espoligotipo de M. tuberculosis y 5 (6.7 por ciento) de M. bovis; de las segundas, 8 (47 por ciento) revelaron espoligotipo de M. tuberculosis y 8 (47 por ciento) de M. bovis. De las 94 muestras positivas al aislamiento o PCR, 66 (70 por ciento) correspondieron a M. tuberculosis y 13 (13.8 por ciento) a M. bovis. Los patrones moleculares de cuatro muestras de M. bovis de seres humanos fueron idénticos a los de las cepas de M. bovis de ganado. CONCLUSIONES: Se demuestra que M. bovis juega un papel importante en la epidemiología de la tuberculosis humana y representa un riesgo para la salud pública.
OBJECTIVE: The purpose of the study was to determine the role of bovine TB in cases of human TB. MATERIAL AND METHODS: Two-hundred and fifty-five samples from symptomatic patients were included in the study. All samples were cultured in Stonebrink and Lowënstein-Jensen media and analyzed using a nested PCRMPB70. The molecular analysis was performed by spoligotyping. RESULTS: From 255 samples, 74 were PCR-positive and 20 were culture-positive. From 94 samples positive to PCR or to isolation, 66 (70 percent) showed a spoligotype compatible with M. tuberculosis, and 13 (13.8 percent) with M. bovis. Four fingerprints of M. bovis from humans were identical to the fingerprints of M. bovis from cattle in the same region. CONCLUSIONS: Our study shows that M. bovis plays an important role in the epidemiology of TB in humans and that TB in cattle represents a risk to public health.