Impacto de la movilidad poblacional en el comportamiento de virus respiratorios durante la pandemia COVID-19 / Impact of population mobility on the behavior of respira tory viruses during the COVID-19 pandemic

Resumen Introducción : Durante la pandemia de SARS-CoV-2 en Argentina se implementaron intervenciones no farma cológicas que produjeron cambios en la movilidad de la población. El objetivo de este estudio fue relacionar los porcentajes de positividad y la diversidad viral con la movi lidad poblacional durante parte del período de restricciones. Métodos : Estudio retrospectivo analítico realizado en el Instituto Médico Platense durante los años 2020 a 2022 que incluyó 458 pacientes a los que se les tomó un hisopado nasofaríngeo para la búsqueda de patóge nos respiratorios por PCR multiplex. Se analizaron los cambios en la movilidad de la población utilizando los "Informes de Movilidad Local", herramienta desarrollada por Google, cuyos datos son de público acceso. Resultados : La movilidad poblacional se correlacionó significativamente con el porcentaje de positividad de las muestras (p = <0.01; R2 = 0.89) y la diversidad viral (p = 0.04; R2 = 0.78). Discusión : Las intervenciones no farmacológicas destinadas a limitar la propagación del SARS-CoV-2 tuvieron efecto en la circulación de otros virus respi ratorios, hallándose mayor porcentaje de positividad y diversidad a medida que las mismas disminuyeron su grado de restricción.

Abstract Introduction : During the SARS-CoV-2 pandemic, Ar gentina population suffered from significant changes in population mobility due to non-pharmaceutical interventions. The aim of this study was to describe the impact of the mobility restrictions to the rates of positivity and diversity among different respiratory viruses. Methods : Retrospective analytical study per formed at Instituto Médico Platense in La Plata that included 458 patients with nasopharyngeal swab to search for respiratory pathogens by multiplex PCR. Changes in mobility were studied using "Community Mobility Reports", data set developed by Google and publicly available. Results : Community mobility had significant cor relation with the percentages of viral test positiv ity (p = < 0.01; R2=0.89) and viral diversity (p = 0.04; R2 = 0.78). Discussion : Non-pharmaceutical interventions estab lished to contain SARS-CoV-2 spread had a significant impact in the circulation patterns of other respiratory viruses.

NPS (Net Promoter Score). Métrica de la experiencia del cliente: construcción y análisis del indicador de una cobertura médica privada / NPS (Net Promoter Score), Customer experience metrics.: construction and analysis of the indicator of private medical coverage

Introducción: el NPS (Net Promoter Score) es un indicador que se utiliza en los programas de experiencia del cliente para medir la satisfacción de dicho público objetivo y su lealtad. Nuestra finalidad fue consolidar el NPS por primera vez en una prepaga de un hospital de alta complejidad de Buenos Aires (PS-HIBA) en busca de establecer un indicador objetivo desde la perspectiva del cliente. Métodos: se realizó un estudio observacional analítico, de corte transversal. Se incluyeron en el estudio los datos obtenidos a partir de las respuestas de los afiliados al PS-HIBA. Resultados: se consolidó el primer indicador NPS del PS-HIBA: 22 puntos. Se visualizaron los tres perfiles de clientes, obteniendo un 45,7% promotores, 22,3% detractores y 32% pasivos o neutros. Complementariamente se identificaron los motivos de dichas calificaciones; las tres principales fueron: la problemática de accesibilidad a los turnos, la atención y los profesionales valorados positivamente. Conclusión: este estudio aporta un indicador objetivo, que facilita un lenguaje común en la organización y una comparación con el mercado desde la mirada del cliente. El NPS, como sistema, busca impulsar la construcción de una cultura centrada en el cliente, con el fin de mejorar su lealtad y permitir una retroalimentación donde se logra tener presente la voz del cliente, e identificar, priorizar y abordar los problemas percibidos. Nos permite establecer los lineamientos de oportunidades de mejora desde la perspectiva de los pacientes. (AU)

Introduction: the NPS (Net Promoter Score) is an indicator used in customer experience programs to measure the satisfaction of said target audience and their loyalty. Our purpose was to send the survey and consolidate the NPS for the first time in a high complexity prepaid hospital in Buenos Aires (PS-HIBA) in search of an objective indicator from the customer's perspective. Methods: an analytical, cross-sectional observational study was carried out. Data obtained from members' responses to the PS-HIBA were included in the study. Results: the first NPS indicator of PS-HIBA was consolidated: 22 points. The three customer profiles were displayed, obtaining 45.7% promoters, 22.3% detractors and 32% passive or neutral. Complementarily, the reasons for these qualifications were identified, being the three main ones: the problem of accessibility to medical appointments, the medical attention and the professionals valued positively. Conclusion: this study provides an objective indicator which facilitates a common language in the organization and a comparison with the market from the customer's point of view.The NPS as a system seeks to promote the construction of a customer-focused culture, in order to improve their loyalty and allow feedback. Thus, it is possible to keep the customer's voice in mind, identify, prioritize and address the perceived problems. It allows us to establish the guidelines for opportunities to improve from the patients' perspective. (AU)

Ceftaroline as salvage therapy for methicillin susceptible staphylococcus aureus complicated bacteremia / Ceftarolina como tratamiento de rescate para la bacteriemia complicada por Staphylococcus aureus sensible a la meticilina

Abstract Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with com plicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.

Resumen Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimen taron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.

Pénfigo paraneoplásico asociado a leucemia linfocítica crónica / PARANEOPLASTIC PENPHIGUS ASSOCIATED TO CHRONIC LYMPHOCYTIC LEUKEMIA

El pénfigo paraneoplásico es una dermatosis ampollar autoimmune asociada a un proceso neoplásico, conocido previamente o no. Se presenta con mayor frecuencia en hombres, entre los 45 y 70 años, pero también puede manifestarse en niños. La clínica es polimorfa. Existen 5 variantes posibles: pénfigo símil, penfigoide ampollar símil, eritema multiforme símil, enfermedad de injerto contra huésped símil y liquen plano símil. Todas ellas comparten una característica en común: la estomatitis severa, dolorosa, progresiva y refractaria a los tratamientos convencionales, que obliga a descartar esta enfermedad. Si bien los antígenos involucrados en su fisiopatogenia son múltiples, la detección de anticuerpos Ig G anti envoplaquina y anti periplaquina constituye el método de diagnóstico más específico. En la actualidad se utilizan los criterios de diagnóstico de Camisa y Helm, que se basan en hallazgos clínicos (erupción mucocutánea polimorfa), histológicos (acantolisis) e inmunohistoquímicos (inmunofluorescencia directa, indirecta e inmunoprecipitación positivas). El abordaje de esta enfermedad debe considerar dos aspectos: el tratamiento del pénfigo en sí y el de la neoplasia asociada, que puede ser benigna (raro) o maligna (con mayor frecuencia). El pronóstico es severo (mortalidad del 75-90%) y en la mayoría de los casos la causa de muerte depende de las complicaciones de la enfermedad, como sepsis y bronquiolitis obliterante. Se presenta un paciente varón de 67 años con PPN asociado a Leucemia Linfocítica Crónica que respondió satisfactoriamente al tratamiento instaurado (meprednisona + quimioterapia con fludarabina, ciclofosfamida y rituximab) y no presentó recidiva a más de 2 años de seguimiento interdisciplinario.

Paraneoplastic pemphigus is an autoimmune blistering disease associated with neoplasms, previously known or not. It occurs most often in men, between 45-70 years, but can also manifest in children. The clinic is polymorphic. There are 5 possible variants: pemphigus-like, bullous pemphigoid-like, erythema multiforme-like, graft versus host disease-like and lichen planus-like. All of them share a common characteristic: a severe, painful, progressive and refractory to conventional treatments stomatitis, which forces us to rule out this disease. Although the antigens involved in its physiopathogenesis are multiple, the detection of anti-envoplakin and anti-periplakin IgG antibodies constitutes the most specific diagnostic method. At present, the diagnostic criteria of Camisa and Helm are used, which are based on clinical (polymorphic mucocutaneous eruption), histological (acantholysis) and immunohistochemical findings (direct and indirect immunofluorescence and immunoprecipitation positive). The approach to this disease must consider two aspects: treatment of the pemphigus as well as the associated neoplasm, which can be benign (rare) or malignant (more frequently). The prognosis is severe (mortality of 75-90%) and in most cases the cause of death depends on the complications of the disease, such as sepsis and bronchiolitis obliterans. We present a 67-year-old male patient with PPN associated with Chronic Lymphocytic Leukemia who responded satisfactorily to the established therapy (meprednisone + chemotherapy with fludarabine, cyclophosphamide and rituximab) and did not present recurrence after more than two years of interdisciplinary follow-up.

Comparison of Glucose Area Under the Curve Measured Using Minimally Invasive Interstitial Fluid Extraction Technology with Continuous Glucose Monitoring System in Diabetic Patients

BACKGROUND: Continuous glucose monitoring (CGM) is reported to be a useful technique, but difficult or inconvenient for some patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hyperglycemia using CGM data as a reference. METHODS: Thirty-eight inpatients with diabetes undergoing CGM were enrolled. MIET comprised a pretreatment step using a plastic microneedle array and glucose accumulation step with a hydrogel patch, which was placed on two sites from 9:00 AM to 5:00 PM or from 10:00 PM to 6:00 AM. IG AUC was calculated by accumulated glucose extracted by hydrogel patches using sodium ion as standard. RESULTS: A significant correlation was observed between the predicted AUC by MIET and CGM in daytime (r=0.76) and nighttime (r=0.82). The optimal cutoff for the IG AUC value of MIET to predict hyperglycemia over 200 mg/dL measured by CGM for 8 hours was 1,067.3 mg·hr/dL with 88.2% sensitivity and 81.5% specificity. CONCLUSION: We showed that 8-hour IG AUC levels using MIET were valuable in estimating the blood glucose AUC without blood sampling. The results also supported the concept of using this technique for evaluating glucose excursion and for screening hyperglycemia during 8 hours in patients with diabetes at any time of day.

Efficacy, safety, tolerability and population pharmacokinetics of tedizolid, a novel antibiotic, in Latino patients with acute bacterial skin and skin structure infections

Abstract Acute bacterial skin and skin structure infections are caused mainly by Gram-positive bacteria which are often treated with intravenous vancomycin, daptomycin, or linezolid, with potential step down to oral linezolid for outpatients. Tedizolid phosphate 200 mg once daily treatment for six days demonstrated non-inferior efficacy, with a favourable safety profile, compared with linezolid 600 mg twice daily treatment for 10 days in the Phase 3 ESTABLISH-1 and -2 trials. The objective of the current post-hoc analysis of the integrated dataset of ESTABLISH-1 and -2 was to evaluate the efficacy and safety of tedizolid (N = 182) vs linezolid (N = 171) in patients of Latino origin enrolled into these trials. The baseline demographic characteristics of Latino patients were similar between the two treatment groups. Tedizolid demonstrated comparable efficacy to linezolid at 48–72 h in the intent-to-treat population (tedizolid: 80.2% vs linezolid: 81.9%). Sustained clinical success rates were comparable between tedizolid- and linezolid-treated Latino patients at end-of-therapy (tedizolid: 86.8% vs linezolid: 88.9%). Tedizolid phosphate treatment was well tolerated by Latino patients in the safety population with lower abnormal platelet counts at end-of-therapy (tedizolid: 3.4% vs linezolid: 11.3%, p = 0.0120) and lower incidence of gastrointestinal adverse events (tedizolid: 16.5% vs linezolid: 23.5%). Population pharmacokinetic analysis suggested that estimated tedizolid exposure measures in Latino patients vs non-Latino patients were similar. These findings demonstrate that tedizolid phosphate 200 mg, once daily treatment for six days was efficacious and well tolerated by patients of Latino origin, without warranting dose adjustment.

Construction of three new Gateway® expression plasmids for Trypanosoma cruzi

We present here three expression plasmids for Trypanosoma cruzi adapted to the Gateway® recombination cloning system. Two of these plasmids were designed to express trypanosomal proteins fused to a double tag for tandem affinity purification (TAPtag). The TAPtag and Gateway® cassette were introduced into an episomal (pTEX) and an integrative (pTREX) plasmid. Both plasmids were assayed by introducing green fluorescent protein (GFP) by recombination and the integrity of the double-tagged protein was determined by western blotting and immunofluorescence microscopy. The third Gateway adapted vector assayed was the inducible pTcINDEX. When tested with GFP, pTcINDEX-GW showed a good response to tetracycline, being less leaky than its precursor (pTcINDEX).

Comparação entre as administrações tópica e sistêmica de oxitetraciclina no tratamento de vacas com dermatite digital papilomatosa / Efficacy of topical and systemic treatments with oxytetracycline for papillomatous digital dermatitis in cows

Comparou-se a eficiência dos tratamentos tópico e sistêmico com oxitetraciclina em vacas com dermatite digital papilomatosa (DDP) e determinaram-se a presença de resíduos desse antimicrobiano no leite e sua concentração no líquido sinovial e no plasma. Utilizaram-se o tratamento tópico com oxitetraciclina em pó (grupo 1) e o sistêmico de longa ação (grupo 2) em 16 vacas holandesas em lactação, acometidas por DDP. Obtiveram-se amostras de plasma, líquido sinovial e leite nos momentos: M0, antes dos tratamentos; M1, seis horas após o tratamento e em intervalos de 12 horas até M23 (264 horas pós-tratamentos). Avaliaram-se o grau de claudicação, a extensão da lesão e a concentração da oxitetraciclina pela cromatografia líquida de alta eficiência. Nas vacas do grupo 1, ocorreu redução das lesões e da claudicação, quando comparadas com as do grupo 2. Nenhuma das amostras de leite, de líquido sinovial e de plasma nos animais do grupo 1 foi positiva para oxitetraciclina. As amostras de leite dos animais do grupo 2, entre M1 e M23, apresentaram valores acima do limite máximo residual permitido para esse antimicrobiano. O tratamento tópico foi eficiente no tratamento de DDP, sem produzir resíduos no leite ou concentrações no plasma e no líquido sinovial. O tratamento sistêmico foi ineficiente para DDP, resultando em resíduos no leite, durante a avaliação.

The efficacy of topical versus systemic treatment with oxytetracycline for papillomatous digital dermatitis (PDD) in dairy cows was compared. Antimicrobial residues in milk and their concentrations in synovial fluid and plasma were analysed. Sixteen lactating Holstein cows with PDD lesions were topically treated with oxytetracycline powder (group 1) or long-acting oxytetracycline (group 2). Plasma, synovial fluid, and milk samples were collected in the following moments: M0 (before treatments); at six hours after treatments (M1), and at 12-hour intervals until 264 hours after treatments (M23). Lameness score and lesion size were evaluated. Analysis of oxytetracycline concentration was performed by high-performance liquid chromatography (HPLC). Cows in group 1 showed reduced lesion size and lameness score when compared to cows in group 2. None of the plasma, synovial fluid, or milk samples collected from cows in group 1 were positive to oxytetracycline. However, violative antimicrobial residues were detected in milk samples collected from cows in group 2, from M1 until M23. Topical application of oxytetracycline powder was an efficient treatment for PDD with no risk of violative antimicrobial residues in milk or increases its concentration in plasma or synovial fluid. The systemic administration of oxytetracycline was inefficient to treat PDD and caused violative residues in milk.

Avaliaçäo do conhecimento sobre doenças sexualmente transmissíveis (DSTs) e síndrome da imunodeficiência adquirida (AIDS) entre universitários de Ribeiräo Preto/SP / Evaluation of the knowledge on sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) among universitary students of Ribeiräo Preto/SP

Com o objetivo de avaliar o grau de conhecimento sobre DST/AIDS entre universitários de diferentes áreas, submeteu estudantes de uma faculdade de Ribeiräo Preto-SP a questionários com perguntas abertas e fechadas, anônimos após aquiescência. As respostas foram categorizadas como corretas (C), incorretas (I), entendimento incompleto (EI) e prejudicadas (P), sendo a análise realizada por porcentagens. De 1.200 estudantes, 961 (80,80 por cento) participaram do estudo. O número de respostas näo foi harmonioso para os diferentes itens do questionário. A área em que o aluno estava matriculado näo pareceu influenciar nas respostas. Com relaçäo à transmissäo do HIV, em 2.914 respostas obteve-se 65,37 por cento como categoria EI e em 923 (31,68 por cento) como C. Quanto a medidas preventivas contra a AIDS de 1888 respostas, 1.625 (86,07 por cento) como categoria C e 207 (10,96 por cento) como EI. Sobre medidas preventivas contra AIDS, utilizadas pelo aluno, 1.126 (74,42 por cento) como categoria C e 249 (16,46 por cento) e P. Quanto a medidas preventivas contra DSTs, 1.339 (71,11 por cento) como categoria C e 284 (15,80 por cento) obteve-se 1. Sobre medidas preventivas contra DSTs utilizadas pelo aluno, obteve-se 542 (43,92 por cento) como categoria C e 350 (28,36 por cento) como P. Os universitários em sua maioria parecem possuir um conhecimento teórico correto sobre as medidas preventivas contra à AIDS e DST e entendimento incompleto sobre a transmissäo do HIV. Provavelmente existem fatores relacionados à educaçäo ou culturais que impedem aos universitários fazerem uso das medidas preventivas que conhecem. Há necessidade de identificaçao desses fatores para que os programas de difusäo possam atingir os seus objetivos. A educaçäo continuada ainda se mostra necessária.

Temas obstetricos y ginecologicos 2 ginecologia practica / Fear obstetric and gynecological 2

Contiene:Consulta ginecologica basica; metodos complementarios de diagnostico; el reisgo en ginecologia; epidemiologia del cancer ginecologico en Bolivia; fisiologia de la mestruacion y alteraciones del ritmo mestrual; dismenorrea; amenorrea; menopausia; flujo genital; embarazo ectopico; anticoncepcion y seleccion del metodo; patologia cervical neoplasica; aborto ante la ley; afecciones gineco-dermatologiacas