Papel de la persona navegadora del paciente en el cáncer de pulmón / The Role of the Navigator Person for a Patient with Lung Cancer

Introducción: la medicina basada en el valor ha logrado mejorar la calidad de atención del paciente y/o la satisfacción de las personas, reduciendo costos y obteniendo mejores resultados. Se apoya sobre tres pilares básicos: la medicina basada en la evidencia, la atención centralizada en el paciente, y la sustentabilidad. Sin embargo, existen pocas publicaciones sobre la estrategia de personas navegadoras para pacientes con cáncer de pulmón, que podrían ser una herramienta clave para brindar apoyo, asegurando que tengan acceso al conocimiento y los recursos necesarios a fin de completar la vía de atención clínica recomendada. Estado del arte: se trata de una intervención en salud cuyo objetivo principal es lograr vencer las barreras relacionadas con la atención (p. ej., logísticas, burocrático-administrativas, de comunicación y financieras) para poder mejorar la calidad y el acceso a la salud en el marco de la atención del cáncer. Estas personas cumplen un papel de guía para pacientes durante el proceso de diagnóstico y tratamiento activo. Su labor consiste en vincular al paciente con los proveedores clínicos, brindar un sistema de apoyo, asegurar un acompañamiento individualizado, garantizar que tengan acceso al conocimiento y a los recursos necesarios para completar el seguimiento y/o tratamiento adecuado. Discusión/Conclusión: indudablemente, es un elemento cada vez más reconocido en los programas de cáncer, centrado en el paciente y de alta calidad. Su implementación será de especial interés en la Unidad de Práctica Integrada para personas con cáncer de pulmón. (AU)

Introduction: Value-based medicine has succeeded in improving the quality of patient care and or patient satisfaction, reducing costs, and obtaining better outcomes. It rests on three fundamental pillars: evidence-based medicine, patient-centered care, and sustainability. However, there are few publications on the people navigator strategy for lung cancer patients, which could be a crucial tool for providing support, ensuring that they have access to the knowledge and resources needed to complete the recommended clinical care pathway. State of the art: It is a health intervention whose main objective is to overcome care-related barriers (e.g., logistical, bureaucratic-administrative, communication, and financial) to improve quality and access to health in the context of cancer care. These individuals play a guiding role for patients during the diagnostic and active treatment process. Their job is to link the patient with clinical providers, provide a support system, ensure individualized accompaniment, and guarantee that they get access to the knowledge and resources necessary to complete the appropriate follow-up and, or treatment. Discussion/Conclusion: Undoubtedly, patient navigators represent an increasingly recognized element of high-quality, patient-centered cancer programs. Its implementation will be of specific interest in the Integrated Practice Unit for people with lung cancer. (AU)

Editing the Human Genome with CRISPR/Cas: A Review of its Molecular Basis, Current Clinical Applications, and Bioethical Implications

ABSTRACT CRISPR/Cas genes evolved in prokaryotic organisms as a mechanism of defense designed to identify and destroy genetic material from threatening viruses. A breakthrough discovery is that CRISPR/Cas system can be used in eukaryotic cells to edit almost any desired gene. This comprehensive review addresses the most relevant work in the CRISPR/Cas field, including its history, molecular biology, gene editing capability, ongoing clinical trials, and bioethics. Although the science involved is complex, we intended to describe it in a concise manner that could be of interest to diverse readers, including anyone dedicated to the treatment of patients who could potentially benefit from gene editing, molecular biologists, and bioethicists. CRISPR/Cas has the potential to correct inherited diseases caused by single point mutations, to knock-in the promoter of a gene whose expression is highly desirable or knockout the gene coding for a deleterious protein. CRISPR/Cas technique can also be used to edit ex vivo immune cells and reinsert them in patients, improving their efficiency in attacking malignant cells, limiting the infectious potential of viruses or modulating xenotransplant rejection. Very important bioethical considerations on this topic include the need to internationally regulate its use by ad hoc expert committees and to limit its use until safety and bioethical issues are satisfactorily resolved.

Perfil clínico-epidemiológico e fatores associados à polifarmácia em pacientes em terapia renal substitutiva / Clinical-epidemiological profile and factors associated with polypharmacy in patients on renal replacement therapy / Perfil clínico-epidemiológico y factores asociados a la polifarmacia en pacientes en terapia de reemplazo renalulo espanhol

Esse estudo teve como objetivo descrever o perfil clínico-epidemiológico e fatores associados à polifarmácia de pacientes com insuficiência renal crônica hemodialítica. Trata-se de um estudo epidemiológico de corte transversal com delineamento descritivo-analítico realizado em um centro de hemodiálise no interior da Bahia. Foram avaliados dados sociodemográficos, clínicos, estilo de vida, farmacoterapia e sintomas durante as sessões de hemodiálise. Os medicamentos utilizados pelos pacientes foram classificados conforme a Anatomical Therapeutic Chemical. A análise dos dados foi realizada por meio da estatística descritiva e a associação entre as variáveis categóricas foi obtida por meio do Teste de Qui-quadrado de Pearson, nível de significância de 5%. Do total de 187 participantes, 56,1% eram homens, com idade <60 anos (69,5%), tendo como média de idade 52 (±15,3) anos. Com comorbidade 87,7%, em especial, a hipertensão arterial sistêmica 82,7%, com prevalência de polifarmácia 89,9%. Durante as sessões de hemodiálise os pacientes apresentaram: cefaleia (72,5%), câimbras 84,5%, calafrios 68,4%, tontura 51,3%, dor abdominal 33,7%, dispneia 27,3% e outros sintomas 23,5%. Houve associação estatística entre polifarmácia e tontura (p= 0,029) e dor abdominal (p= 0,009), durante as sessões de hemodiálise. Os medicamentos mais frequentes foram os pertencentes aos grupos anatômicos A (30,4%) e C (23,4%). Verificou-se alta prevalência de polifarmácia, sendo que os resultados obtidos poderão auxiliar gestores e profissionais da área da saúde nas tomadas de decisão, aperfeiçoando assim, a assistência ao paciente com doença renal crônica.

This study aimed to describe the clinical-epidemiological profile and factors associated with polypharmacy in patients with hemodialysis chronic renal failure. This is a cross-sectional epidemiological study with a descriptive-analytical design carried out in a hemodialysis center in the interior of Bahia. Sociodemographic, clinical, lifestyle, pharmacotherapy and symptoms data were evaluated during hemodialysis sessions. The medications used by patients were classified according to the Anatomical Therapeutic Chemical. Data analysis was performed using descriptive statistics and the association between categorical variables was obtained using Pearson's Chi-square test, significance level of 5%. Of the total of 187 participants, 56.1% were men, aged <60 years (69.5%), with a mean age of 52 (±15.3) years. With comorbidity 87.7%, in particular, systemic arterial hypertension 82.7%, with a prevalence of polypharmacy 89.9%. During hemodialysis sessions, patients presented: headache (72.5%), cramps 84.5%, chills 68.4%, dizziness 51.3%, abdominal pain 33.7%, dyspnea 27.3% and other symptoms 23.5%. There was a statistical association between polypharmacy and dizziness (p= 0.029) and abdominal pain (p= 0.009) during hemodialysis sessions. The most frequent medications were those belonging to anatomical groups A (30.4%) and C (23.4%). There was a high prevalence of polypharmacy, and the results obtained could help managers and health professionals in decision-making, thus improving care for patients with chronic kidney disease.

Este estudio tuvo como objetivo describir el perfil clínico-epidemiológico y los factores asociados a la polifarmacia en pacientes con insuficiencia renal crónica en hemodiálisis. Se trata de un estudio epidemiológico transversal, con diseño descriptivo- analítico, realizado en un centro de hemodiálisis del interior de Bahía. Durante las sesiones de hemodiálisis se evaluaron datos sociodemográficos, clínicos, de estilo de vida, farmacoterapéuticos y de síntomas. Los medicamentos utilizados por los pacientes se clasificaron según la Química Terapéutica Anatómica. El análisis de los datos se realizó mediante estadística descriptiva y la asociación entre variables categóricas se obtuvo mediante la prueba Chi-cuadrado de Pearson, nivel de significancia del 5%. Del total de 187 participantes, el 56,1% eran hombres, edad <60 años (69,5%), con una edad media de 52 (±15,3) años. Con comorbilidad 87,7%, en particular hipertensión arterial sistémica 82,7%, con prevalencia de polifarmacia 89,9%. Durante las sesiones de hemodiálisis los pacientes presentaron: dolor de cabeza (72,5%), calambres 84,5%, escalofríos 68,4%, mareos 51,3%, dolor abdominal 33,7%, disnea 27,3% y otros síntomas 23,5%. Hubo asociación estadística entre polifarmacia y mareos (p= 0,029) y dolor abdominal (p= 0,009) durante las sesiones de hemodiálisis. Los medicamentos más frecuentes fueron los pertenecientes a los grupos anatómicos A (30,4%) y C (23,4%). Hubo una alta prevalencia de polifarmacia y los resultados obtenidos podrían ayudar a gestores y profesionales de la salud en la toma de decisiones, mejorando así la atención a los pacientes con enfermedad renal crónica.

Killip-Kimball classification in octogenarians with acute coronary syndrome: an 11-year experience / Clasificación de Killip-Kimball en octogenarios con síndrome coronario agudo: 11 años de experiencia

Abstract Objective: The objective of the study is to validate the use of the Killip-Kimball classification (KC) as a predictor of outcomes in an octogenarian cohort with acute coronary syndrome. Methods: A retrospective analysis of patients who underwent a catheterization procedure for acute coronary syndrome (ACS) was performed. ACS was defined as per the American Heart Association guidelines, and included ST-elevation myocardial infarction (STEMI), non-STEMI and Unstable Angina. We determined factors associated with the KC upon admission to the emergency room. Likewise, we compared in-hospital mortality, length of stay, and other outcomes dividing the patients by KC. Results: A total of 133 patients with a mean age of 83 years were analyzed and assigned a KC from 1 to 4 according to clinical presentation. Each group included 86, 9, 23, and 15 patients, respectively. In-hospital mortality was 12%, 5% in KC-I, 11% in KC-II, 22% in KC-III, and 40% in KC-IV with a significant difference between classes (p = 0.002). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p < 0.01). Conclusion: Despite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher KC have a high mortality rate, as described in younger cohorts. KC remains a reliable prognostic tool, with applicability in octogenarian patients.

Resumen Objetivo: Validar el uso de la clasificación de Killip- Kimball como predictor de desenlaces en una cohorte de pacientes octogenarios con síndrome coronario agudo. Métodos: Se realizó un análisis retrospectivo de pacientes sometidos a cateterismo por síndrome coronario agudo (ACS). Se incluyeron infarto al miocardio con y sin elevación del segment ST, así como angina inestable, utilizando las definiciones de la American Heart Association (AHA). Se determinaron los factores que influyeron en la clasificación de Killip-Kimball (KC) al momento de ingreso al hospital. Se comparó la mortalidad, la estancia intrahospitalaria y otros desenlaces, dividiendo a los pacientes por su KC. Resultados: Un total de 133 pacientes se incluyeron en el análisis y se clasificaron dependiendo de su KC (I-IV). Cada grupo incluyó 86, 9, 23 y 15 pacientes, respectivamente. La edad media fue de 83 años. La mortalidad intrahospitalaria fue de 5, 11, 22 y 40%, respectivamente para cada KC, y 12% global. Hubo una diferencia significativa en la mortalidad por clase (p = 0.002). Adicionalmente, se encontró que a mayor KC, mayor riesgo de lesión renal aguda durante la hospitalización (p < 0.01). Conclusión: A pesar de una reducción en la mortalidad de adultos mayores con ACS en décadas recients, pacientes con ACS y mayor KC tienen riesgo aumentado de morir, igual que pacientes en grupos de edad menores. La KC continñua siendo una herramienta confiable para la clasificación y con utilidad pronóstica, con aplicabilidad en pacientes mayores de 80 años.

Subacute invasive pulmonary aspergillosis misdiagnosed as tuberculosis in a Nigerian man: A case report

Subacute invasive pulmonary aspergillosis is a form of chronic pulmonary aspergillosis (CPA) with rapid progression. The clinical features of CPA mimic tuberculosis (TB) and may lead to delayed and/or misdiagnosis. We report a 39-year-old Nigerian previously managed in a peripheral hospital as a case of TB despite negative Gene-X pert results with no resolution of symptoms. Chest X-ray and computer tomography findings were suggestive of CPA and galactomannan assay positive. Symptoms resolved 2 months into itraconazole treatment. There is a dire need to drive awareness of CPA among clinicians, especially in our primary and secondary healthcare facilities where the knowledge base and expertise in the management of fungal infections is still at a rudimentary level or perhaps not available at all.

Absceso hepático por Enterobius vermicularis como diagnóstico diferencial de metástasis hepática en cáncer colorrectal, reporte de caso / Liver Abscess Caused by Enterobius vermicularis as a Differential Diagnosis for Liver Metastasis in Colorectal Cancer, Case Report

Resumen Introducción: el cáncer colorrectal es la cuarta causa de mortalidad asociada con cáncer en el mundo. La identificación de las metástasis de este tumor en el momento prequirúrgico es cada vez más frecuente por los estudios imagenológicos con los que se cuenta en la actualidad. Presentamos el caso de una paciente con infección por Enterobius vermicularis que simula la presencia de metástasis hepáticas. Presentación del caso: se presenta el caso de una paciente femenina proveniente del área rural, con dolor abdominal de 1 año de evolución asociado con hemorragia de vías digestivas bajas y pérdida de peso. Las imágenes y estudios endoscópicos muestran una lesión tumoral en el colon sigmoide con biopsias que reportan adenocarcinoma de colon sigmoides, además de lesiones hepáticas sugestivas de malignidad. Se llevó a resección anterior de recto y sigmoides con anastomosis alta y toma de biopsias hepáticas, que descartaron la malignidad e informaron la presencia de infección hepática por E. vermicularis. Discusión: La infección por E. vermicularis a nivel hepático presentada en el caso es poco frecuente, dicha infección puede simular la presencia de metástasis hepáticas, por lo cual debe tenerse en cuenta como diagnóstico diferencial de enfermedad metastásica de cáncer colorrectal.

Abstract Introduction: colorectal cancer is the fourth leading cause of cancer-related mortality worldwide. The identification of the metastases of this tumor in the preoperative stage is increasingly frequent due to the imaging studies currently available. We present the case of a patient with an infection caused by Enterobius vermicularis that simulates the presence of liver metastases. Case presentation: a female patient from a rural area showing a one-year abdominal pain evolution associated with lower gastrointestinal tract bleeding and weight loss. Endoscopic imaging and studies displayed a tumor lesion in the sigmoid colon, with biopsies reporting sigmoid colon adenocarcinoma and liver lesions suggesting malignancy. Anterior resection of the rectum and sigmoid was performed with high anastomosis and liver biopsies, which ruled out malignancy and reported the presence of liver infection by E. vermicularis. Discussion: in this case, the hepatic E. vermicularis infection was rare. This infection can simulate the presence of liver metastases; therefore, it should be considered a differential diagnosis of metastatic colorectal cancer.

Cross-cultural adaptation and psychometric evaluation of the Brazilian version of the Temporal Experience of Pleasure Scale (TEPS-Br)

Abstract Introduction: Anhedonia is a critical symptom of major depressive disorder that is defined as the reduced ability to experience pleasure. The Temporal Experience of Pleasure Scale (TEPS) is commonly used to measure anhedonia and has exhibited satisfactory reliability. Objectives: We aim to perform cross-cultural adaptation of a Brazilian version of the TEPS and evaluate its psychometric properties. Method: The cross-cultural adaptation was performed according to previously established protocols. Cronbach's alpha coefficient of internal consistency was used to establish the degree of interrelation and coherence of items. Also, we calculated the intraclass correlation coefficient to determine the stability of the scale after a proposed interval had elapsed and used exploratory factor analysis to evaluate the scale's factor structure and content validity. Principal component analysis was used to determine the factors to be retained in the factor model. Results: The participants reported that the Brazilian version of the TEPS had good comprehensibility and applicability. The results revealed a statistically significant correlation between measures. The intraclass correlation coefficient calculated was significant. The Cronbach's alpha value calculated indicated that the scale's overall internal consistency was adequate. Conclusion: The Portuguese version of the TEPS scale proposed achieved good comprehensibility for the Brazilian population and its psychometric characteristics demonstrated good reliability and validity.

Chagas disease in the context of the 2030 agenda: global warming and vectors

The 2030 Agenda for Sustainable Development is a plan of action for people, planet and prosperity. Thousands of years and centuries of colonisation have passed the precarious housing conditions, food insecurity, lack of sanitation, the limitation of surveillance, health care programs and climate change. Chagas disease continues to be a public health problem. The control programs have been successful in many countries in reducing transmission by T. cruzi; but the results have been variable. WHO makes recommendations for prevention and control with the aim of eliminating Chagas disease as a public health problem. Climate change, deforestation, migration, urbanisation, sylvatic vectors and oral transmission require integrating the economic, social, and environmental dimensions of sustainable development, as well as the links within and between objectives and sectors. While the environment scenarios change around the world, native vector species pose a significant public health threat. The man-made atmosphere change is related to the increase of triatomines' dispersal range, or an increase of the mobility of the vectors from their sylvatic environment to man-made constructions, or humans getting into sylvatic scenarios, leading to an increase of Chagas disease infection. Innovations with the communities and collaborations among municipalities, International cooperation agencies, local governmental agencies, academic partners, developmental agencies, or environmental institutions may present promising solutions, but sustained partnerships, long-term commitment, and strong regional leadership are required. A new world has just opened up for the renewal of surveillance practices, but the lessons learned in the past should be the basis for solutions in the future.

Different profiles and epidemiological scenarios: past, present and future

The multiplicity of epidemiological scenarios shown by Chagas Disease, derived from multiple transmission routes of the aetiological agent, occurring on multiple geo-ecobiosocial settings determines the complexity of the disease and reveal the difficulties for its control. From the first description of the link between the parasite, the vector and its domestic habitat and the disease that Carlos Chagas made in 1909, the epidemiological scenarios of the American Trypanosomiasis has shown a dynamic increasing complexity. These scenarios changed with time and geography because of new understandings of the disease from multiple studies, because of policies change at the national and international levels and because human movements brought the parasite and vectors to new geographies. Paradigms that seemed solid at a time were broken down, and we learnt about the global dispersion of Trypanosoma cruzi infection, the multiplicity of transmission routes, that the infection can be cured, and that triatomines are not only a health threat in Latin America. We consider the multiple epidemiological scenarios through the different T. cruzi transmission routes, with or without the participation of a Triatominae vector. We then consider the scenario of regions with vectors without the parasite, to finish with the consideration of future prospects.

Satellite clinics of the Newborn Screening Continuity Clinic - Region 6: Establishment of a Community-Based Networking System in Western Visayas, Philippines

Background@#With the increasing coverage of the newborn screening (NBS) program in the Philippines, the number of patients being followed-up has also been increasing. The NBS continuity clinics (NBSCCs) have continuously been creating strategies to improve long-term patient health outcomes. @*Objective@#This paper aimed to describe the establishment of a community-based networking system of satellite clinics. @*Methodology@#A document review of resources including powerpoint presentations, a local ordinance, Newborn Screening Reference Center database of statistics of the NBSCCs from 2015 to 2021 and a Department of Health - Center for Health Development memorandum was done. @*Results@#NBS satellite clinics were developed as a strategy for improving the tracking and long-term follow-up of patients confirmed for one of the conditions in the NBS panel. Satellite clinics offering long-term follow-up services were set up in hospitals strategically located in the provinces of the Western Visayas, especially in areas with a high number of patients. Capacity building activities were initiated among the established NBS satellite clinic core teams which were composed of doctors, nurses, and/or midwives. A total of 15 satellite clinics spread out across the six provinces of Western Visayas were established in 2017. By the end of 2020, the Western Visayas region had a total of 528 confirmed patients endorsed by the Newborn Screening Center Visayas (NSC V) and the recall rate increased from 62.77 % in 2015 to 87.79 % in 2020. @*Conclusion@#The establishment of satellite clinics provided a region-wide accessibility and availability of longterm follow-up services to the patients as seen by the increase in the patient recall rate. The benefits were seen especially during the implementation of strict border controls due to the pandemic which ensured the continuity of care of the patients in the region. This concept can serve as a model for other NBSCCs in the archipelago and for other regions across the Philippines.

Parámetros ecocardiográficos relacionados a hipertensión arterial pulmonar en pacientes con leucemia mieloide crónica en tratamiento con dasatinib / Echocardiographic parameters related to pulmonary arterial hypertension in patients with chronic myeloid leukemia under dasatinib treatment

Introducción: La leucemia mieloide crónica (LMC) es un desorden clonal de células madre hematopoyéticas, predomina en el género masculino entre 55 y 65 años. El ecocardiograma transtorácico (ECOTT) para detección temprana de hipertensión arterial pulmonar (HAP) permite hacer modificaciones al tratamiento con dasatinib. Ojetivos: Determinar los parámetros ecocardiográficos y la probabilidad ecocardiográfica para HAP en pacientes con LMC tratados con dasatinib. Métodos: Estudio de correlación, transversal, retrospectivo, unicéntrico; se incluyeron pacientes con LMC tratados con dasatinib. Se utilizó correlación de Spearman y Pearson. Resultados: Se analizaron 16 pacientes, edad promedio 53,5 años; 62,5% hombres, 37,5% mujeres. La dosis de dasatinib fue 50 mg/día en 18,7%, y 100 mg/día en 81,2%, presión media de la arteria pulmonar (mPAP) 26,3 mmHg, velocidad máxima de regurgitación tricuspídea (VmxRT) media 2,9 m/s, presión sistólica de arteria pulmonar (PSAP) media 41 mmHg. El 56,2% presentó disfunción diastólica del ventrículo derecho (DDVD). Se categorizaron 43% en baja probabilidad para HAP, 18,7% intermedia y 37,5% en alta. Relación entre mPAP y VmxRT con p=0,012. Relación entre mPAP y función diastólica del ventrículo derecho (FDVD), con p=0,002. Relación entre probabilidad para HAP y mPAP, con p=0,008. Conclusión: Los parámetros ecocardiográficos mPAP, VmxRT, PSAP, DDVD son útilesy la probabilidad ecocardiográfica para HAP deben realizarse de forma temprana y como seguimiento, ya que se encontró relación positiva con la presencia de HAP, la cual no es dependiente del tiempo de tratamiento ni de la dosis de dasatinib.

Introduction: The use of dasatinib in patients with CML has improved life expectancy and follow-up with transthoracic echocardiography (ECOTT) for early detection of PAH allows modifications to the treatment. Objectives: To determine the echocardiographic parameters and echocardiographic probability for PAH in patients with CML treated with dasatinib. Methods: Correlation, cross-sectional, retrospective, single-center study; patients with CML treated with dasatinib were included. Spearman and Pearson correlation was used. Results: 16 patients were analyzed, mean age 53.5 years; 62.5% men, 37.5% women. The dasatinib dose was 50 mg / day in 18.7%, and 100 mg / day in 81.2%, mean pulmonary arterial pressure (mPAP) 26.3 mmHg, mean maximum tricuspid regurgitation velocity (VmxRT) 2.9 m / s, mean pulmonary artery systolic pressure (PSAP) 41 mmHg. 56.2% had right ventricular diastolic dysfunction (RVDD). 43% were categorized as low probability for PAH, 18.7% intermediate, and 37.5% as high. Relationship between PAPm and VmxRT with p = 0.012. Relationship between mPAP and RV diastolic function, with p = 0.002. Relationship between probability for PAH and mPAP, with p = 0.008. Conclusions: The echocardiographic parameters PAPm, VmxRT, PSAP, DDVD and echocardiographic probability for PAH are useful and necessary for the diagnosis of PAH. The determination of all these parameters should be carried out early and as a follow-up, since a considerable positive relationship was found for each one with the presence of PAH, which is not dependent on the treatment time or the dose of dasatinib.

Cambio climático y enfermedades transmitidas por vectores en Argentina / Climate change and vector-borne diseases in Argentina

Resumen Las enfermedades transmitidas por vectores (ETVs) continúan siendo un desafío para los esfuerzos de agencias de salud pública, ya que mantienen o están aumentando su impacto sobre la salud de las comunidades afectadas. La característica común de las ETVs es que la única manera de prevenir exito samente nuevas infecciones es evitar el contacto entre vectores y humanos. No existen vacunas y no existirán en un futuro previsible para las principales ETVs que afectan la salud pública en Argentina. Aunque las epide mias de dengue desde 2009 atrajeron la atención mediática, otras ETVs, tales como Chagas o leishmaniasis, afectan la salud pública en Argentina desde hace décadas. Sobre ellas, y otras que potencialmente podrían instalarse en el territorio nacional (West Nile, Lyme, etc) hay repetidas referencias mediáticas que explican su recrudecimiento por el cambio climático. El argumento se basa en que la "tropicalización" del clima en regiones templadas promueve la instalación de ETVs en áreas previamente no favorables para ellas. Aunque existen muchas evidencias de que el clima está cambiando, son pocas las evidencias de que sea el clima el principal factor que promueve el recrudecimiento de las ETVs en Argentina. En este artículo, se discute la situación de los vectores de enfermedades en Argentina (con énfasis en triatominos), su vinculación con el llamado cambio climático y las actividades de control de vectores implementados por agencias gubernamentales de salud pública.

Abstract Vector-borne diseases (VBDs) continue to pose a challenge to the efforts of public health agencies by increasing their impact on the health of the affected communities. The common feature of VBDs is that the only way of preventing them is by avoid ing the contact between vectors and humans. There are no vaccines, and they will not be available shortly as tools for prevention and control in Argentina. Although dengue outbreaks attracted the attention of mass media from 2009, other VBDs have been affecting public health in Argentina for many decades, as Chagas disease and leishmaniasis. Over these, and others that could potentially settle in the national territory (West Nile, Lyme, etc.), there are repeated mass media claims and political declarations justifying their increase because of climate changes. The argument asserts that the "tropicalization" of the climate in temperate regions promotes the instal lation of VBDs in areas previously unfavorable for them. Although much evidence exists showing that the climate is changing, there is very little evidence that the climate is the main factor promoting the increase of VBDs. In this article, the influence of the so-called climate change on the situation of disease vectors in Argentina (with emphasis on triatomines) and vector control activities implemented by governmental public health agencies are discussed.

Interrupción voluntaria del embarazo en Latinoamérica, superando barreras / Voluntary interruption of the pregnancy in Latin America, overcoming barriers

Resumen Introducción: El embarazo no planeado o no intencional y el aborto son situaciones que afectan la vida de mujeres a nivel mundial, sin distinción de etnia, edad, riqueza, o ubicación geográfica, sin embargo, tiene una mayor posibilidad de presentarse y generar consecuencias negativas en mujeres con ciertas determinantes sociales. Objetivo: Mostrar el estado actual de la interrupción voluntaria del embarazo en países de Latinoamérica y del Caribe con énfasis en el reciente avance de la legislación argentina sucedido durante diciembre del 2020. Metodología: Se realizó una búsqueda no estructurada de información sobre la legislación del aborto en países de Latinoamérica y del Caribe y se hizo una revisión de tema sobre aspectos actuales y relevantes de la interrupción voluntaria del embarazo. Conclusiones: Es necesario que prestadores de servicios de salud y sociedad latinoamericana repasen las lecciones aprendidas de diferentes países sobre las consecuencias negativas para la salud de las mujeres y sus familias debido a las restricciones para acceder al aborto seguro. El mejoramiento de la calidad y las capacidades de los sistemas de salud en los países de bajos y medianos recursos, con mayor inversión e investigación en temas de salud sexual y reproductiva, resultará en la eliminación de barreras e inequidades en la prestación de atención médica a las mujeres, respetando sus derechos y autonomía.

Abstract Introduction: Unplanned or unintended pregnancy and abortion are situations that affect the lives of women worldwide without distinction of ethnicity, age, economic level, or geographical location. However, they have a greater probability of occurring and negative consequences in women with certain social determinants. Objective: Our main objective is to show the current state of the Voluntary Interruption of Pregnancy in Latin American and Caribbean countries with special emphasis on the recent advance of the legislation of Argentina that occurred last December. Methodology: An unstructured search for information about Abortion Legislation in Latin American and Caribbean countries was carried out and a subject revision on current and relevant aspects of Voluntary Interruption of Pregnancy was made. Conclusions: It is necessary that as Health Service providers and as a Latin American Society, we review the lessons learned from different countries about the negative consequences on the health of women and their families due to the restrictions for accessing legal abortions. Improving the quality and capacity of the health system in low- and middle- income countries, in addition to greater investment and research in sexual and reproductive health issues, will derive a removal of barriers and inequity related to the provision of medical attention for women while respecting their rights and autonomy.

Agents of pneumonia in slaughtered pigs in southern Brazil / Agentes patogênicos de pneumonia em suínos abatidos no sul do Brasil

A high prevalence of pneumonic lesions has been reported to affect slaughtered pigs in southern Brazil. In order to identify which microorganisms have been causing those lesions, 30 pig lungs presenting pneumonic gross lesions were collected from five different slaughterhouses, totaling 150 lungs. Samples for bacterial isolation, molecular, histopathologic and immunohistochemistry (IHC) evaluation were taken from each lung. The pneumonic lesion scoring ranged from 1.53 to 2.83. The most frequent histopathological lesions found was the concomitant Influenza A virus (IAV) and Mycoplasma hyopneumoniae infection, corresponding to 55.3% (83/150), and Pasteurella multocida type A was isolated in 54.2% (45/83) of these cases. In 102 samples (68%), there was histopathologic suggestion of involvement of more than one infectious agent. M. hyopneumoniae was the most frequent agent associated with pneumonic lesions, being present in 92.1% (94/102) of the lungs with coinfections, followed by IAV in 89.2% (91/102). Besides the coinfections, IAV lesions were observed also in six samples without another pathogenic microorganism detected. A total of 46 samples with acute and subacute IAV suspected lesions in histopathological examination were assessed for IHC and real time RT-PCR for IAV. A total of 35% (16/46) of them were positive by IHC and 13% (6/46) by real time RT-PCR. Regarding M. hyopneumoniae, 79.3% (119/150) of samples were positive by qPCR and 84.9% (101/119) of them also presented M. hyopneumoniae suspected lesions in the histopathological examination. The results of this study suggest the importance of IAV in respiratory diseases in finishing pigs, even though this virus is more frequently reported in the nursery phase. In addition, our results emphasize the importance of lung coinfections in finishing pigs.(AU)

Lesões sugestivas de pneumonia são frequentemente encontradas em altas prevalências em suínos abatidos no sul do Brasil. Para identificar quais microrganismos causam essas lesões, foram coletados 30 pulmões de suínos com lesão macroscópica sugestiva de pneumonia em cinco frigoríficos diferentes, totalizando 150 pulmões. Amostras para isolamento bacteriano, avaliação molecular, histopatológica e imuno-histoquímica (IHC) foram coletadas de cada pulmão. O escore de lesão pulmonar variou entre 1,53 a 2,83. O achado histopatológico mais observado foi a lesão sugestiva de infecção concomitante pelo vírus Influenza A (IAV) e Mycoplasma (M.) hyopneumoniae, correspondendo a 55,3% (83/150), e em 54,2% (45/83) desses casos Pasteurella (P.) multocida tipo A foi isolado. Em 102 amostras (68%), houve lesão histopatológica sugestiva do envolvimento de mais de um agente infeccioso. M. hyopneumoniae foi o microrganismo mais frequente associado a lesões de pneumonia, estando presente em 92,1% (94/102) dos pulmões com coinfecções, seguido de IAV, que foi encontrado em 89,2% (91/102). Além das coinfecções, lesões de IAV foram observadas em mais seis amostras que não aparentavam envolvimento de outro agente infeccioso. Um total de 46 amostras com suspeita de lesão aguda e subaguda de IAV no exame histopatológico foram avaliadas para IHC e RT-PCR em tempo real para IAV e 35% (16/46) delas foram positivas por IHC e 13% (6/46) foram positivas por RT-PCR em tempo real. Com relação a M. hyopneumoniae, 79,3% (119/150) das amostras foram positivas por qPCR e 84,9% (101/119) delas também apresentaram lesões suspeitas de M. hyopneumoniae no exame histopatológico. Os resultados deste trabalho sugerem a importância do IAV como agente causador de pneumonias em suínos de terminação, embora esse vírus seja mais frequentemente relatado na fase de creche. Além disso, os achados deste trabalho demonstram a presença frequente de coinfecções pulmonares em suínos de terminação.(AU)

Agents of pneumonia in slaughtered pigs in southern Brazil

ABSTRACT: A high prevalence of pneumonic lesions has been reported to affect slaughtered pigs in southern Brazil. In order to identify which microorganisms have been causing those lesions, 30 pig lungs presenting pneumonic gross lesions were collected from five different slaughterhouses, totaling 150 lungs. Samples for bacterial isolation, molecular, histopathologic and immunohistochemistry (IHC) evaluation were taken from each lung. The pneumonic lesion scoring ranged from 1.53 to 2.83. The most frequent histopathological lesions found was the concomitant Influenza A virus (IAV) and Mycoplasma hyopneumoniae infection, corresponding to 55.3% (83/150), and Pasteurella multocida type A was isolated in 54.2% (45/83) of these cases. In 102 samples (68%), there was histopathologic suggestion of involvement of more than one infectious agent. M. hyopneumoniae was the most frequent agent associated with pneumonic lesions, being present in 92.1% (94/102) of the lungs with coinfections, followed by IAV in 89.2% (91/102). Besides the coinfections, IAV lesions were observed also in six samples without another pathogenic microorganism detected. A total of 46 samples with acute and subacute IAV suspected lesions in histopathological examination were assessed for IHC and real time RT-PCR for IAV. A total of 35% (16/46) of them were positive by IHC and 13% (6/46) by real time RT-PCR. Regarding M. hyopneumoniae, 79.3% (119/150) of samples were positive by qPCR and 84.9% (101/119) of them also presented M. hyopneumoniae suspected lesions in the histopathological examination. The results of this study suggest the importance of IAV in respiratory diseases in finishing pigs, even though this virus is more frequently reported in the nursery phase. In addition, our results emphasize the importance of lung coinfections in finishing pigs.

RESUMO: Lesões sugestivas de pneumonia são frequentemente encontradas em altas prevalências em suínos abatidos no sul do Brasil. Para identificar quais microrganismos causam essas lesões, foram coletados 30 pulmões de suínos com lesão macroscópica sugestiva de pneumonia em cinco frigoríficos diferentes, totalizando 150 pulmões. Amostras para isolamento bacteriano, avaliação molecular, histopatológica e imuno-histoquímica (IHC) foram coletadas de cada pulmão. O escore de lesão pulmonar variou entre 1,53 a 2,83. O achado histopatológico mais observado foi a lesão sugestiva de infecção concomitante pelo vírus Influenza A (IAV) e Mycoplasma (M.) hyopneumoniae, correspondendo a 55,3% (83/150), e em 54,2% (45/83) desses casos Pasteurella (P.) multocida tipo A foi isolado. Em 102 amostras (68%), houve lesão histopatológica sugestiva do envolvimento de mais de um agente infeccioso. M. hyopneumoniae foi o microrganismo mais frequente associado a lesões de pneumonia, estando presente em 92,1% (94/102) dos pulmões com coinfecções, seguido de IAV, que foi encontrado em 89,2% (91/102). Além das coinfecções, lesões de IAV foram observadas em mais seis amostras que não aparentavam envolvimento de outro agente infeccioso. Um total de 46 amostras com suspeita de lesão aguda e subaguda de IAV no exame histopatológico foram avaliadas para IHC e RT-PCR em tempo real para IAV e 35% (16/46) delas foram positivas por IHC e 13% (6/46) foram positivas por RT-PCR em tempo real. Com relação a M. hyopneumoniae, 79,3% (119/150) das amostras foram positivas por qPCR e 84,9% (101/119) delas também apresentaram lesões suspeitas de M. hyopneumoniae no exame histopatológico. Os resultados deste trabalho sugerem a importância do IAV como agente causador de pneumonias em suínos de terminação, embora esse vírus seja mais frequentemente relatado na fase de creche. Além disso, os achados deste trabalho demonstram a presença frequente de coinfecções pulmonares em suínos de terminação.

Reducing pain and opioid consumption after body contouring of the breast by application of a perioperative nerve block: a systematic review

Background@#Pain in the postoperative body contouring patient has traditionally been managed with narcotic medication. In an effort to minimize side effects and prevent addiction, plastic surgeons are searching for novel ways to provide adequate analgesia, one of which is nerve blocks. This study was conducted with a meta-analysis that evaluates the efficacy of these blocks for patients who undergo breast surgery. @*Methods@#A search of the PubMed/MEDLINE database for articles including the terms “postoperative analgesia” OR “postoperative pain management” AND “in plastic surgery” OR “in cosmetic surgery” OR “in elective surgery” in February 2019 generated five studies on elective breast augmentation and reduction mammoplasty that reported pain scores and quantities of opioids consumed. Independent samples t-tests, one-way analysis of variance, and a random effects model were implemented for evaluation. @*Results@#A total of 317 patients were identified as having undergone body contouring of the breast, about half of which received a nerve block. Pain scores on a 1–10 scale and opioid dose-equivalents were calculated. Those who were blocked had an average score of 2.40 compared to 3.64 for those who did not (P<0.001), and required an average of 5.20 less narcotic doses (P<0.001). Pain relief following subpectoral augmentation was best achieved with type-II blocks as opposed to type-I and type-II with serratus plane (P<0.001). @*Conclusions@#The opioid epidemic has extended to all surgical specialties. Implementation of a nerve block seems to be an efficacious and cost-effective mechanism to not only help with postoperative pain, but also lower the need for narcotics, especially in subpectoral augmentation.

Reducing pain and opioid consumption after body contouring of the breast by application of a perioperative nerve block: a systematic review

Background@#Pain in the postoperative body contouring patient has traditionally been managed with narcotic medication. In an effort to minimize side effects and prevent addiction, plastic surgeons are searching for novel ways to provide adequate analgesia, one of which is nerve blocks. This study was conducted with a meta-analysis that evaluates the efficacy of these blocks for patients who undergo breast surgery. @*Methods@#A search of the PubMed/MEDLINE database for articles including the terms “postoperative analgesia” OR “postoperative pain management” AND “in plastic surgery” OR “in cosmetic surgery” OR “in elective surgery” in February 2019 generated five studies on elective breast augmentation and reduction mammoplasty that reported pain scores and quantities of opioids consumed. Independent samples t-tests, one-way analysis of variance, and a random effects model were implemented for evaluation. @*Results@#A total of 317 patients were identified as having undergone body contouring of the breast, about half of which received a nerve block. Pain scores on a 1–10 scale and opioid dose-equivalents were calculated. Those who were blocked had an average score of 2.40 compared to 3.64 for those who did not (P<0.001), and required an average of 5.20 less narcotic doses (P<0.001). Pain relief following subpectoral augmentation was best achieved with type-II blocks as opposed to type-I and type-II with serratus plane (P<0.001). @*Conclusions@#The opioid epidemic has extended to all surgical specialties. Implementation of a nerve block seems to be an efficacious and cost-effective mechanism to not only help with postoperative pain, but also lower the need for narcotics, especially in subpectoral augmentation.

Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost-effectiveness analysis / 부인종양

Objective@#To assess the potential cost-effectiveness of prehabilitation in medically frail patients undergoing surgery for epithelial ovarian cancer (EOC). @*Methods@#We created a cost-effectiveness model evaluating the impact of prehabilitation on a cohort of medically frail women undergoing primary surgical intervention for EOC. Cost was assessed from the healthcare system perspective via (1) inpatient charges from 2018–2019 institutional Diagnostic Related Grouping data for surgeries with and without major complications; (2) nursing facility costs from published market surveys. Major complication and non-home discharge rates were estimated from the literature. Based on published pilot studies, prehabilitation was determined to decrease these rates. Incremental cost-effectiveness ratio for cost per life year saved utilized a willingness-to-pay threshold of $100,000/life year. Modeling was performed with TreeAge software. @*Results@#In a cohort of 4,415 women, prehabilitation would cost $371.1 Million (M) versus $404.9 M for usual care, a cost saving of $33.8 M/year. Cost of care per patient with prehabilitation was $84,053; usual care was $91,713. When analyzed for cost-effectiveness, usual care was dominated by prehabilitation, indicating prehabilitation was associated with both increased effectiveness and decreased cost compared with usual care. Sensitivity analysis showed prehabilitation was more cost effective up to a cost of intervention of $9,418/patient. @*Conclusion@#Prehabilitation appears to be a cost-saving method to decrease healthcare system costs via two improved outcomes: lower complication rates and decreased care facility requirements. It represents a novel strategy to optimize healthcare efficiency. Prospective studies should be performed to better characterize these interventions in medically frail patients with EOC.

Experiencia clínica con el uso ambulatorio de tolvaptan. Costes y efectividad en nueve casos / Clinical experience with Tolvaptan outpatient use. Cost and effectiveness in 9 cases

Resumen Introducción: La introducción de tolvaptan ha supuesto la principal novedad en el tratamiento de la hiponatremia en los últimos años. Objetivo: Describir la experiencia con tolvaptan en el Complejo Asistencial Universitario de León, España. Método: Estudio observacional retrospectivo de utilización ambulatoria de tolvaptan en un hospital de tercer nivel, de marzo de 2014 a agosto de 2017. Resultados: Fueron tratados con tolvaptan de forma ambulatoria nueve pacientes, 23.1 % alcanzó eunatremia en 24 horas. Posterior a la administración de tolvaptan se registró reducción en días de hospitalización (361 versus 70, p = 0.007), especialmente por hiponatremia (306 versus 49, p = 0.009). Conclusiones: El uso a largo plazo de tolvaptan parece ser seguro y se relaciona con descenso en los días de hospitalización.

Abstract Introduction: Tolvaptan introduction has constituted the main therapeutic novelty in the management of hyponatremia in recent years. Objective: To describe the experience with this drug at Complejo Asistencial Universitario de León, Spain. Method: Retrospective, observational study of tolvaptan outpatient use in a tertiary care hospital from March 2014 to August 2017. Results: A total of 9 patients were treated with tolvaptan in the outpatient setting. Eunatremia was reached in 24 h by 23.1%. After tolvaptan administration, a reduction in days of hospitalization was recorded (361 vs. 70; p = 0.007), especially in those days of hospitalization that were attributable to hyponatremia (306 vs. 49; p = 0.009). Conclusions: Long-term use of tolvaptan appears to be safe and is associated with a decrease in days of hospitalization.

Polyethylene spinout in the Attune® Cruciate-Retaining Rotating-Platform (CR RP) total knee arthroplasty performed with a cruciate-sacrificing and measuredresection technique

Methods@#We used a retrospective radiological review from two centres reporting a higher rate of spinout in the Attune® CR RP knee using a cruciate-sacrificing and measured-resection technique when compared to a gapbalancing technique. Three hundred and thirty-two patients were evaluated over a 3-year period. @*Results@#There were 8 out of 279 (2.86%) cases of spinout in our first cohort of patients using a measured-resection technique. There were 0 out of 53 cases of spinout in our second cohort of patients where a gap-balancing technique was used. One spinout was reduced closed, the other seven were initially revised to a thicker RP insert of the same design. Of these seven, three underwent a further revision TKA and one patient required a knee fusion/arthrodesis. @*Conclusions@#This study reports a higher incidence of PE spinout in the Attune® CR RP TKA when a measuredresection technique in combination with PCL resection is performed. We recommend a gap-balancing technique with conservative soft-tissue release if the surgeon is planning to sacrifice the PCL in the Attune® CR RP.