Implementación de Navegadores de Pacientes en distintos sectores del "Hospital Nacional Profesor Alejandro Posadas" / Implementation of patient browsers in different sectors of the "National Hospital Professor Alejandro Posadas"

En el año 2020 en el Hospital Nacional Profesor Alejandro Posadas, cuando comenzó la pandemia de Covid 2019, se comenzó a realizar seguimiento clínico de pacientes y a sus contactos, en forma telefónica, debido a la gran demanda de asistencia y para evitar el desborde del sistema sanitario. Conformándose así el equipo de Seguimiento Telefónico. Consecuencia de aquello comprobamos que era una herramienta valiosa que podría ser utilizada en otros procesos. En el año 2021 el equipo de Seguimiento Telefónico continuó en funcionamiento adaptándose a nuevas líneas de trabajo en donde el monitoreo de la trazabilidad del cuidado de los pacientes es imprescindible para garantizarles acceso al sistema y al mismo tiempo realizar evaluación y monitoreo de procesos asistenciales que involucran a personas con criterios de vulnerabilidad y/o salud que les confieran riesgo. Este artículo explora el papel que puede desempeñar la "Navegación del Paciente" en la mejora de los resultados de salud1 . Los navegadores pueden facilitar un mejor acceso y calidad de la atención médica para las poblaciones desatendidas. En el mes de febrero de 2023 se institucionalizó el dispositivo de Seguimiento Telefónico como sector de Revinculación Asistencial, un arma más para beneficiar a los pacientes, aumentando su Seguridad y mejorando día a día la Calidad de atención.

In 2020, when the Covid-19 pandemic began, the Professor Alejandro Posadas National Hospital implemented clinical monitoring of patients and their contacts by telephone to manage the overwhelming demand for assistance and avoid overcrowding. This led to the formation of a Telephone Monitoring team. The team's success prompted the hospital to explore other areas where the tool could be applied. In 2021, the hospital continued to use the Telephone Monitoring team, adapting it to new lines of work where patient care traceability was critical for ensuring access to the healthcare system. This article examines the role of patient navigation in improving healthcare outcomes, including better access and quality of care for underserved populations. The hospital institutionalized the Telephone Monitoring device in February 2023 as a sector of Assistance Relinking, adding another weapon to benefit patients by increasing their safety and improving the quality of care.

Detection of Shiga Toxin-Producing Escherichia coli (STEC) in the Endocervix of Asymptomatic Pregnant Women. Can STEC Be a Risk Factor for Adverse Pregnancy Outcomes?

The presence of Escherichia coli in the vaginal microbiome has been associated with pregnancy complications. In previous works, we demonstrated that Shiga toxin-producing Escherichia coli (STEC) can produce abortion and premature delivery in rats and that Shiga toxin type 2 (Stx2) can impair human trophoblast cell lines. The hypothesis of this work was that STEC may colonize the lower female reproductive tract and be responsible for adverse pregnancy outcomes. Thus, the aim of this work was to evaluate the presence and prevalence of virulence factor genes from STEC in the endocervix of asymptomatic pregnant women. For that purpose, endocervical swabs were collected from pregnant women during their prenatal examination. Swab samples were enriched in a differential medium to select Enterobacteria. Then, positive samples were analyzed by PCR to detect genes characteristic of Escherichia sp. (such as uidA and yaiO), genes specific for portions of the rfb (O-antigen-encoding) regions of STEC O157 (rfbO157), and STEC virulence factor genes (such as stx1, stx2, eae, lpfAO113, hcpA, iha, sab, subAB). The cytotoxic effects of stx2-positive supernatants from E. coli recovered from the endocervix were evaluated in Vero cells. Our results showed that 11.7% of the endocervical samples were positive for E. coli. Additionally, we found samples positive for stx2 and other virulence factors for STEC. The bacterial supernatant from an isolate identified as E. coli O113:NT, carrying the stx2 gene, exhibited cytotoxic activity in Vero, Swan 71 and Hela cells. Our results open a new perspective regarding the presence of STEC during pregnancy.

Prevalencia de la infección por Mycoplasma genitalium en mujeres embarazadas / Prevalence of Mycoplasma genitalium infection in pregnant women / Prevalência da infecção por Mycoplasma genitalium em gestantes

Resumen Durante los últimos 5-10 años se ha considerado a Mycoplasma genitalium como un agente emergente de infecciones de transmisión sexual. Su papel en el embarazo ha sido poco estudiado. La prevalencia en la Argentina es desconocida. El objetivo del trabajo fue determinar la prevalencia de M. genitalium en muestras endocervicales de mujeres embarazadas que concurrieron a un control ginecológico. La metodología utilizada para la detección fue una PCR de punto final que amplifica una secuencia específica del gen mgpB. Se estudiaron 270 mujeres embarazadas entre 15 y 42 años. La prevalencia global de M. genitalium fue de 5,2% (14/270). De las sintomáticas el 10% eran positivas (9/90) y de las pacientes asintomáticas 2,8% eran positivas (5/180). El 1,5% (4/270) presentó coinfección con Chlamydia trachomatis. Todas cursaban un embarazo de más de 12 semanas. Este es el primer trabajo de prevalencia de M. genitalium realizado en mujeres embarazadas en la Argentina. Se necesitan más estudios de asociación entre este microorganismo y las complicaciones en el embarazo para avanzar hacia la prevención y el control de esta infección.

Abstract Mycoplasma genitalium has been considered an emerging agent of sexually transmitted infections for the past 5-10 years. Its association with agent of non-gonococcal urethritis in men is well recognized. In women it has been linked to cervicitis, endometritis and pelvic inflammatory disease. Its role in pregnancy has been poorly studied. In Argentina, the prevalence is unknown. The objective of this work was to determine the prevalence of M. genitalium in endocervical samples of pregnant women who attended a gynecological control. An end-point PCR was used to amplify a specific sequence of the mgpB gene. A group of 270 pregnant women between 15 and 42 years were studied. The overall prevalence of M. genitalium was 5.2% (14/270). Among the symptomatic patients, 10% were positive (9/90), whereas among the asymptomatic patients, 2.8% were positive (5/180). Only 1.5% (4/270) presented co-infection with Chlamydia trachomatis. This is the first prevalence study on M. genitalium performed on pregnant women in Argentina. More studies are needed to understand the relationship between this microorganism and complications during pregnancy, in order to prevent and control this infection in women.

Resumo O Mycoplasma genitalium tem sido considerado um agente de infecções sexualmente transmissível emergente nos últimos 5 a 10 anos. Seu papel na gravidez tem sido pouco estudado. Na Argentina, a prevalência é desconhecida. O objetivo deste trabalho foi determinar a prevalência de M. genitalium em amostras endocervicais de gestantes que realizaram controle ginecológico. Uma PCR de ponto final foi utilizada como metodologia para a detecção, que amplifica uma sequência específica do gene mgpB. Um grupo de 270 gestantes entre 15 e 42 anos foi estudado. A prevalência geral de M. genitalium foi de 5,2% (14/270). Entre as pacientes sintomáticas, 10% foram positivas (9/90), ao passo que entre as assintomáticas, 2,8% foram positivas (5/180). Apenas 1,5% (4/270) apresentou coinfecção por Chlamydia trachomatis. Todas as mulheres estudadas estavam grávidas fazia mais de 12 semanas. Este é o primeiro estudo de prevalência sobre M. genitalium realizado em mulheres grávidas na Argentina. Mais estudos de associação entre esse microorganismo e as complicações na gravidez são necessários, a fim de avançar na prevenção e no controle desta infecção.

Prevalencia de Chlamydia trachomatis en mujeres embarazadas del Hospital Nacional "Prof. Alejandro Posadas" / OCCURRENCE OF CHLAMYDIA T. IN PREGNANT WOMEN AT THE NATIONAL HOSPITAL " A. POSADAS"

Objetivo: Detectar la prevalencia de Chlamydia t. en mujeres embarazadas del Hospital Prof. A. Posadas. Materiales y método. Diseño: Se realizó un estudio observacional descriptivo y prospectivo, en el servicio de Obstetricia del Hospital Nacional Prof. Dr. A. Posadas en Argentina, en el área de Patología Tracto Genital Inferior durante el período comprendido entre Octubre 2015 a Enero del año 2016. A todas las mujeres embarazadas que concurrieron a realizarse el Papanicolaou y colposcopía, se les extrajo muestras del contenido vaginal y endocervical. Las muestras endocervicales fueron analizadas por Técnica Real Time por PCR. Criterios de Inclusión: Todas las mujeres embarazadas que llegan al consultorio de Área Patología Tracto Genital Inferior por 1ra vez a realizarse un Papanicolaou. Resultados: El total de mujeres embarazadas estudiadas en ese periodo fue de 270, de las cuales el 12,22 % (33) fueron positivas para la banda de amplificación compatible con ADN de Chlamydia t. De las positivas el 73 % de las embarazadas (24) eran menores de 25 años. De las 270 mujeres embarazadas estudiadas el 57,40 % fueron menores de 25 años (155). Esto coincide con la casuística internacional que sugiere la búsqueda de Chlamydia t. en todas las mujeres menores de 25 años. Además, de las 33 (12%) que fueron positivas para Chlamydia t., 22 (67%) de ellas fueron asintomáticas. Conclusiones: Se sugiere el screening rutinario de Chlamydia t. por PCR a todas las mujeres embarazadas menores de 25 años, para evitar las graves complicaciones neonatales como así también las complicaciones puerperales frecuentes por esta infección.

The order Chlamydiales contains only a single genus, Chlamydia, and three species C. psittaci, C trachomatis, and C pneumonia. All three are obligate, intracellular parasites with a relatively complex life cycle. C trachomatis is capable of infecting transitional and columnar epithelial cells of the conjunctiva, respiratory tract, and urogenital tract. Untreated infection may resolve spontaneously or progress to a low-grade persistent infection. In either case, it usually can produce serious sequelae moreover if it is reactivated or a reinfection occurs. Objective: the aim of the present report was to detect the prevalence of Chlamydia trachomatis in pregnant women in the "A. Posadas" Hospital. Design: an observational descriptive and prospective survey was performed, at the Obstetric Service of the National tal "A. Posadas" from Argentina, in the Area of Lower Genital Tract Pathology, during the period between October 2015 through January 2016. To all the pregnant women assisted to perform a Papanicolaou test and colposcopy, samples of the vaginal and endocervical content were obtained, . The endocervical samples were analyzed by Real Time Technique. Results: The total of the pregnant women studied in that period were 270, of whom 12,22% (33) were positive with the AND of Chlamydia t. From the positive patients 73 % of the pregnants (24) were younger than 25 years. Out of the 270 pregnant women studied, 57,40% were younger than 25 years (155). These data coincide with the international casuistics that suggests a searching for Chlamydia t. in all women younger than 25 years. Besides, of the 33 (12%) that were positives for Chlamydia t. , 22 (67%) were asymptomatic. Conclusions: It is suggested the rutinary screening for Chlamysia t. in all the pregnant women younger than 25 years, to avoid the severe neonatal complications and also the puerperal complications frecquent in this infection.