Estudio descriptivo de adultos con Diabetes Mellitus Tipo 1: caracterizando una población poco explorada / Descriptive study of adults with type 1 diabetes: characterizing an underexplored population

La diabetes mellitus tipo 1 (DM1) es una enfermedad crónica autoinmune, con una incidencia creciente a nivel mundial. Los avances en el diagnóstico y en el tratamiento de los últimos años prolongaron la esperanza de vida, aumentando así el número de adultos con DM1. Se realizó un corte transversal que incluyó 201 personas adultas con diagnóstico de DM1, afiliados activos a la prepaga institucional de un hospital de alta complejidad de Argentina a Marzo de 2020. Se consignaron las siguientes variables: edad, sexo, comorbilidades, presencia de complicaciones, control glucémico y tratamiento farmacológico. Hubo un porcentaje similar de hombres y mujeres (51,2%), con una mediana de edad de 45 años (IIC 31-59). Un tercio de la población era mayor de 65 años. La mediana de evolución desde el diagnóstico fue de 14,5 años, y la mediana de último valor de hemoglobina glicosilada fue de 7,9%. Entre las complicaciones microvasculares más frecuentes se mencionan pie diabético (18%), retinopatía (6%) y nefropatía (2%). Un 4% presentó enfermedad cardiovascular (infarto agudo de miocardio, enfermedad coronaria, accidente cerebrovascular y/o enfermedad vascular periférica). El 88% recibía tratamiento con esquema intensificado de insulina y 6% usaban infusores de insulina. En relación al tratamiento con antidiabéticos orales, solo 11% recibían metformina, mientras que el uso de otros antidiabéticos orales fue inferior al 4%. En conclusión, este estudio proporciona valiosa información sobre las características de los adultos con DM1, dado que no hay demasiados estudios que aborden esta población (AU)

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease, with an increasing incidence worldwide. Advances in diagnosis and treatment in recent years have extended life expectancy, thus increasing the number of adults with T1DM. A cross-sectional study was conducted, including 201 adult individuals diagnosed with T1DM, active members of the institutional health plan of a high-complexity hospital in Argentina as of March 2020. The following variables were recorded: age, gender, comorbidities, presence of complications, glycemic control, and pharmacological treatment. There was a similar percentage of men and women (51.2%), with a median age of 45 years (IQR 31-59). One-third of the population was over 65 years old. The median duration since diagnosis was 14.5 years, and the median of the last glycated hemoglobin value was 7.9%. Among the most frequent microvascular complications, diabetic foot (18%), retinopathy (6%), and nephropathy (2%) were mentioned. 4% had cardiovascular disease (acute myocardial infarction, coronary artery disease, stroke, and/or peripheral vascular disease). 88% received treatment with intensified insulin regimens, and 6% used insulin pumps. Regarding treatment with oral antidiabetic drugs, only 11% received metformin, while the use of other oral antidiabetic drugs was less than 4%. In conclusion, this study provides valuable information about the characteristics of adults with T1DM, as there are not many studies that address this population (AU)

Use of carbon from the agricultural industry for the synthesis of catalysts destined to oxyanions removal from water.

Remediation of water contaminated with oxyanions is of great importance due to the toxicity and environmental persistence of these chemical species. The present work describes the elimination of different oxyanions in water using catalysts supported on active carbon obtained from an agricultural residue (peanut shells, CPeanut) and active commercial carbon (CCom) in order to compare their structural and catalytic properties. The synthesized CPeanut and CCom were fully characterized by surface analysis, TGA, TPR, SEM-EDX, FT-IR, and TEM. It was observed that CPeanut presented similar superficial characteristics to CCom, being an adequate support to synthesize catalysts. With both carbons, catalysts based on Cu, Pd, and PdCu were prepared and evaluated in the elimination of NO3-, NO2-, and BrO3- from water using H2 as a reducing agent. The bimetallic catalysts prepared on both supports were active in the oxyanions reduction, obtaining good selectivities to the products of interest. In this sense, this work presents a potential re-use of agricultural wastes by preparing activated carbon from peanut shell residues in order to reduce the waste volume generated. In addition, the material synthetized is low cost due to its large-scale production and great availability in Argentina. The carbon obtained from the peanut shells provides a potential application in the environmental remediation of water contaminated with oxyanions.

COVID-19 vaccines reduce mortality in hospitalized patients with oxygen requirements: Differences between vaccine subtypes. A multicontinental cohort study.

The aim of this study was to analyze whether the coronavirus disease 2019 (COVID-19) vaccine reduces mortality in patients with moderate or severe COVID-19 disease requiring oxygen therapy. A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals), was conducted. We evaluated hospitalized patients for COVID-19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression and propensity score matching. We also performed a subgroup analysis according to vaccine type. The adjusted model was used to determine the population attributable risk. Between January 2020 and May 2022, we evaluated 21,479 COVID-19 hospitalized patients with oxygen requirements. Of these, 338 (1.5%) patients received a single dose of the COVID-19 vaccine and 379 (1.8%) were fully vaccinated. In vaccinated patients, mortality was 20.9% (95% confidence interval [CI]: 17.9-24), compared to 19.5% (95% CI: 19-20) in unvaccinated patients, resulting in a crude odds ratio (OR) of 1.07 (95% CI: 0.89-1.29; p = 0.41). However, after considering the multiple comorbidities in the vaccinated group, the adjusted OR was 0.73 (95% CI: 0.56-0.95; p = 0.02) with a population attributable risk reduction of 4.3% (95% CI: 1-5). The higher risk reduction for mortality was with messenger RNA (mRNA) BNT162b2 (Pfizer) (OR 0.37; 95% CI: 0.23-0.59; p < 0.01), ChAdOx1 nCoV-19 (AstraZeneca) (OR 0.42; 95% CI: 0.20-0.86; p = 0.02), and mRNA-1273 (Moderna) (OR 0.68; 95% CI: 0.41-1.12; p = 0.13), and lower with Gam-COVID-Vac (Sputnik) (OR 0.93; 95% CI: 0.6-1.45; p = 0.76). COVID-19 vaccines significantly reduce the probability of death in patients suffering from a moderate or severe disease (oxygen therapy).

Temporal trends in hematopoietic stem cell transplantation in Argentina between 2009 and 2018: A collaborative study by GATMO-TC and INCUCAI.

INTRODUCTION: Hematopoietic stem cell transplantation is the only curative treatment for many disorders and international data shows a growing trend. METHOD: We aimed to evaluate the temporal trends in HSCT transplant rates in Argentina. A time-series analysis was performed for the period 2009 to 2018 using the national database from the National Central Coordinating Institute for Ablations and Implants. Crude and standardized transplant rates were calculated. A permutation joinpoint regression model analysis was used to identify significant changes over time. RESULTS: Altogether, 8,474 transplants were reported to INCUCAI by 28 centers (autologous 67.5%); the main indication was multiple myeloma (30%). The WHO age-sex standardized HSCT rates for the entire country were 153.3 HSCT/10 million inhabitants (95% CI 141.7-165.8) in 2009 and 260.1 HSCT/10 million inhabitants (95% CI 245.5-275.5) in 2018. There was a large gap in HSCT rates among the states and regions. The transplant rate was higher for autologous transplants throughout the years. Within the allogeneic group, the related donor transplant rate was higher than the unrelated donor transplant rate. The joinpoint regression analysis of HSCT rates for the whole country over time showed an observed annual percentage change of 6.3% (95% CI 5.4-7.3; p < 0.01). No changes were observed for unrelated donors during the study period. CONCLUSIONS: Age-sex standardized HSCT rates in Argentina are increasing, mainly due to autologous and family donor allogeneic transplants. A wide variation across the country was found, demonstrating differences in the access to transplantation among Argentine regions.

Temporal trends in hematopoietic stem cell transplantation in Argentina between 2009 and 2018: A collaborative study by GATMO-TC and INCUCAI

Special Article Introduction Hematopoietic stem cell transplantation is the only curative treatment for many disorders and international data shows a growing trend. Method We aimed to evaluate the temporal trends in HSCT transplant rates in Argentina. A time-series analysis was performed for the period 2009 to 2018 using the national database from the National Central Coordinating Institute for Ablations and Implants. Crude and standardized transplant rates were calculated. A permutation joinpoint regression model analysis was used to identify significant changes over time. Results Altogether, 8,474 transplants were reported to INCUCAI by 28 centers (autologous 67.5%); the main indication was multiple myeloma (30%). The WHO age-sex standardized HSCT rates for the entire country were 153.3 HSCT/10 million inhabitants (95% CI 141.7-165.8) in 2009 and 260.1 HSCT/10 million inhabitants (95% CI 245.5-275.5) in 2018. There was a large gap in HSCT rates among the states and regions. The transplant rate was higher for autologous transplants throughout the years. Within the allogeneic group, the related donor transplant rate was higher than the unrelated donor transplant rate. The joinpoint regression analysis of HSCT rates for the whole country over time showed an observed annual percentage change of 6.3% (95% CI 5.4-7.3; p< 0.01). No changes were observed for unrelated donors during the study period. Conclusions Age-sex standardized HSCT rates in Argentina are increasing, mainly due to autologous and family donor allogeneic transplants. A wide variation across the country was found, demonstrating differences in the access to transplantation among Argentine regions.

Catalytic hydrogenation of nitrate in water: improvement of the activity and selectivity to N2 by using Rh(III)-hexamolybdate supported on ZrO2-Al2O3.

Catalysts prepared on ZrO2, Al2O3 and ZrO2-Al2O3 (ZrAl-10) supported with Anderson heteropolyanion (RhMo6) as active phase were investigated for the elimination of NO3- from water. Raman characterization of pure and supported RhMo6 phase showed the presence of polymolybdic species of different degrees of complexity when RhMo6 was supported. The temperature-programmed reduction study revealed the synergic effect between Rh and Mo species, through which the reducibility of Mo was promoted by Rh, and different phase/support interactions were verified. Among the supports, ZrAl-10 presented the highest acidity due to the presence of ZrO2 in the tetragonal modification and high specific surface area (due to Al2O3), favouring rhodium-molybdenum active phase/support interaction and high dispersion. All catalysts prepared were active in removing NO3-, the one prepared with the RhMo6 phase on the ZrAl-10 support being the most active. These results point to the formation of an active surface with a high dispersion of Rh and Mo. The highest selectivity to N2 (99.3) exhibited by the RhMo6/ZrAl-10 catalyst is proposed to be related to the high Rh dispersion (0.755) and to the presence of Lewis acid sites (oxygen vacancies) of the tetragonal ZrO2 modification that favour NO3- adsorption through electrostatic interactions.

Vacunas COVID-19 y su protección contra la mortalidad intrahospitalaria / COVID-19 vaccines and their protection against in-hospital mortality

INTRODUCCIÓN El desarrollo de varias vacunas contra COVID-19 demostró su eficacia para reducir los malos resultados clínicos, incluida la muerte, con una eficacia superior al 90 % para evitar la hospitalización. OBJETIVOS Analizar si la vacuna contra COVID-19 reduce la mortalidad en pacientes con enfermedad COVID-19 moderada o grave que requieren oxigenoterapia. MÉTODOS Se realizó un estudio de cohortes retrospectivo, con datos de 148 hospitales tanto de España (111) como de Argentina (37). Se evaluó a pacientes hospitalizados por COVID-19 mayores de 18 años con requerimientos de oxígeno. La protección de la vacuna frente a la muerte se evaluó mediante regresión logística multivariable y propensity score matching. También se realizó un análisis de subgrupos según el tipo de vacuna. El modelo ajustado se utilizó para determinar el Riesgo Atribuible Poblacional. RESULTADOS Entre enero de 2020 y mayo de 2022, se evaluó a 21 479 pacientes hospitalizados por COVID-19 con necesidades de oxígeno. De ellos, 338 pacientes (1,5 %) recibieron una dosis única de la vacuna contra COVID-19 y 379 (1,8 %) fueron vacunados en su totalidad. En los pacientes vacunados, la mortalidad fue del 20,9 % (IC95% 17,9-24 %), frente al 19,5 % (IC95% 19-20 %) en los pacientes no vacunados, lo que dio lugar a una Odds Ratio (OR) bruta de 1,07 (IC95% 0,89-1,29; p=0,41). Sin embargo, tras considerar las múltiples comorbilidades en el grupo vacunado, la OR ajustada fue de 0,73 (IC95% 0,56-0,95; p=0,02) con una reducción del Riesgo Atribuible a la Población del 4,3% (IC95% 1-5 %). La mayor reducción del riesgo de mortalidad se produjo con el ARNm BNT162b2 (Pfizer) (OR de 0,37 [IC95% 0,23-0,59; p<0,01]), ChAdOx1 nCoV-19 (AstraZeneca) (OR de 0,42 [IC95% 0.20-0,86; p=0,02]) y mRNA-1273 (Moderna) (OR de 0,68 [IC95% 0,41-1,12; p=0,13]), y menor con Gam-COVID-Vac (Sputnik) (OR de 0,93 [IC95% 0,6-1,45; p=0,76]). DISCUSIÓN Las vacunas contra COVID-19 reducen significativamente la probabilidad de muerte en pacientes que padecen una enfermedad moderada o grave (oxigenoterapia).

Association between non-attendance to outpatient clinics and emergency department consultations, hospitalizations and mortality in a Health Maintenance Organization.

BACKGROUND: Non-attendance to scheduled medical appointments in outpatient clinics is a problem that affects patient health and health-care systems. OBJECTIVE: Evaluate association of non-attendance to scheduled appointments in outpatient clinics and Emergency Department (ED) visits, hospitalizations and mortality. METHODS: Retrospective cohort study of outpatients enrolled in 2015 to 2016 in the Hospital Italiano de Buenos Aires HMO with over five scheduled appointments. Individual non-attendance proportion was obtained by dividing missed over scheduled appointment numbers in the 365 days prior to index date. Outcomes were evaluated with a Cox proportional-hazards or Fine and Gray model for competing risks. We adjusted by several variables. RESULTS: Sixty-five thousand two hundred sixty-five adults were included. Mean age was 63.6 years (SD 18.16), 29.9% male. Outpatients had average 10.18 (SD 5.59) appointments. Non-attendance the year before the index appointment had a median of 20%. A 10% increase in non-attendance was significantly associated with ED visits (asHR 1.19; 95%CI 1.08-1.32, P < .001) and all-cause mortality (aHR 7.57; 95%CI 4.88-11.73, P < .001). In the matched subcohort analysis we observed a crude significant association of non-attendance with ED visits (P < .001) and all-cause mortality (P < .001). DISCUSSION: Our findings show non-attendance could be a marker of health events that lead to emergency department evaluations and/or death.