La aplicación del saber médico. Hipertensión y daño cognitivo

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Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.

Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.

Beyond cancer treatment: dermo-aesthetic and other wellness recommendations for breast cancer patients.

Breast cancer, a prevalent malignancy among women, has various physical and psychological impacts. This comprehensive review offers an in-depth look at multidisciplinary dermo-aesthetic intervention approaches, emphasizing the balance between oncological therapies and the management of these effects. The information presented spans specialties such as aesthetic medicine, plastic surgery, dermatology, physiotherapy, nutrition, odontology, and gynecology. This review, which serves as a clinical guide, aims to establish a safe protocol for non-medical interventions involving oncologists, physicians, and specialists from various areas in patients with breast cancer focused on improving their quality of life. This work offers personalized and integrative care strategies for the eradication of cancer. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment.

Comparative membrane proteomic analysis of Tritrichomonas foetus isolates.

Tritrichomonas foetus is a flagellated and anaerobic parasite able to infect cattle and felines. Despite its prevalence, there is no effective standardized or legal treatment for T. foetus-infected cattle; the vaccination still has limited success in mitigating infections and reducing abortion risk; and nowadays, the diagnosis of T. foetus presents important limitations in terms of sensitivity and specificity in bovines. Here, we characterize the plasma membrane proteome of T. foetus and identify proteins that are represented in different isolates of this protozoan. Additionally, we performed a bioinformatic analysis that revealed the antigenicity potential of some of those proteins. This analysis is the first study to identify common proteins at the plasma membrane of different T. foetus isolates that could be targets for alternative diagnostic or vaccine techniques in the future.

Predictores de riesgo de deterioro cognitivo leve en una población de hipertensos / Predictors of Mild Cognitive Impairment in a Hypertensive Population

RESUMEN Introducción. El estatus cognitivo es considerado un biomarcador del daño vascular encefálico en la hipertensión arterial (HTA). Es fundamental en pacientes con HTA la pesquisa del deterioro cognitivo leve (DCL). Objetivos . Valorar la presencia de factores predictores de DCL en pacientes hipertensos. Material y métodos . Estudio observacional, transversal, en el periodo 2015-2023. Se incluyeron pacientes mayores de 18 años, asistidos en policlínica que hubieran realizado la Evaluación Cognitiva de Montreal (MoCA). Se consideró valor de MoCA alterado uno < 24. Se excluyeron pacientes con dificultades motoras, sensoriales, enfermedad psiquiátrica, analfabetismo. Las variables cualitativas se presentan como frecuencias absolutas y relativas, y para el estudio de asociación se utilizó test de Chi cuadrado. Las variables cuantitativas se presentan como media y desviación estándar, y el estudio de diferencias se realizó con test T de Student para muestras independientes. En el análisis de regresión logística múltiple se colocaron aquellas variables significativas en el análisis univariado por el método Forward. Nivel de significación alfa = 0,05. Resultados . 129 pacientes, mujeres: hombres 2:1; edad promedio 60 años. El 79,1 % tenía HTA grado 3, 30,4 % presentaban más de 20 años de evolución de HTA. El 52,7% tenía escolarización primaria. Un 89,4 % presentaba sobrepeso-obesidad, el 36,4 % tabaquismo, 29,7 % dislipidemia mixta. Un 65,1% presentó un valor de MoCA ≥ 24 y el 34,9 % un valor < 24. En el modelo predictor logístico, las variables evolución en años de HTA, dislipidemia mixta, y enfermedad cerebrovascular fueron predictoras de riesgo de MoCA alterado. El nivel educativo terciario fue factor protector. Conclusión . La identificación de factores predictores de daño cognitivo es prioritaria para una acción preventiva. En este estudio las variables tiempo de evolución de la HTA, dislipidemia mixta, enfermedad cerebrovascular y nivel educativo permitieron predecir mayor riesgo de DCL.

ABSTRACT Background . Cognitive status is considered a biomarker of vascular brain damage caused by hypertension (HTN). Screening for mild cognitive impairment (MCI) is essential in patients with HTN. Objectives . The aim of this study was to evaluate the presence of predictors of MCI in hypertensive patients. Methods . We conducted an observational and cross-sectional study between 2015 and 2023. All the patients > 18 years treated in a clinic and who were evaluated with the Montreal Cognitive Assessment (MoCA) were included. A score < 24 in the MoCA test was considered abnormal. Patients with motor or sensory impairment, psychiatric disorders, or illiteracy were excluded. Qualitative variables are presented as absolute frequencies and percentages, and the chi-square test was used to analyze their association. Quantitative variables are expressed as mean ± standard deviation and were compared with the independent samples t-test. All the variables with statistical significance in the univariate analysis through forward selection were included in the multiple logistic regression analysis. A p value < 0.05 was considered statistically significant. Results . A total of 129 patients were included (women-to-men ratio 2:1; mean age 60 years); 79.1% had stage 3 HTN, time from HTN diagnosis was > 20 years in 30.4%, 52.7% had complete primary education, 89.4% had overweight/obesity, 36.4% were smokers and 29.7% had mixed dyslipidemia. A score ≥ 24 in the MoCA was present in 65.1% and 34.9% had a score < 24. The logistic predictor model identified time from HTN diagnosis, mixed dyslipidemia and cerebrovascular disease as predictors of abnormal MoCA. A tertiary educational level had a protective effect. Conclusion . Identifying predictors of cognitive impairment is a priority to take preventive actions. In this study, time from HTN diagnosis, mixed dyslipidemia, cerebrovascular disease and educational level were associated with cognitive impairment.

Production of poly (3-hydroxybutyrate) and extracellular polymeric substances from glycerol by the acidophile Acidiphilium cryptum.

Acidiphilium cryptum is an acidophilic, heterotrophic, and metallotolerant bacteria able to use dissolved oxygen or Fe(III) as an electron sink. The ability of this extremophile to accumulate poly(3-hydroxybutyrate) (PHB) and secrete extracellular polymeric substances (EPS) has also been reported. Hence, the aim of this work is to characterize the production of PHB and EPS by the wild strain DSM2389 using glycerol in shaken flasks and bioreactor. Results showed that maximum PHB accumulation (37-42% w/w) was obtained using glycerol concentrations of 9 and 15 g L-1, where maximum dry cell weight titers reached 3.6 and 3.9 g L-1, respectively. The culture in the bioreactor showed that PHB accumulation takes place under oxygen limitation, while the redox potential of the culture medium could be used for online monitoring of the PHB production. Recovered EPS was analyzed by Fourier-transform infrared spectroscopy and subjected to gas chromatography-mass spectrometry after cleavage and derivatization steps. These analyses showed the presence of sugars which were identified as mannose, rhamnose and glucose, in a proportion near to 3.2:2.3:1, respectively. Since glycerol had not been used in previous works, these findings suggest the potential of A. cryptum to produce biopolymers from this compound at a large scale with a low risk of microbial contamination due to the low pH of the fermentation process.

Telemedicina en el control de la hipertensión arterial

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Introduction: Arterial hypertension is the great challenge of health policies in the world. Its high prevalence, the lack of control (linked to poor adherence to antihypertensive treatment) and its high "burden" (as a non-communicable disease) are responsible for the increase in cardiovascular morbidity and mortality. Objetive: To evaluate, as a pilot test, the benefit of real-time telemonitoring applied to blood pressure (BP) control. Metodology: Inclusion criteria: Diagnosed hypertensives, under pharmacological treatment, assisted in the Maciel Hospital polyclinic in the period June-October 2019. Exclusion criteria: pregnancy and upper arm circumference less than 22 cm or greater than 42 cm. Home blood pressure monitoring was implemented, using a validated electronic blood pressure monitor and a smart cell phone connected to a private web platform in real time. Analytical, experimental, prospective study. Qualitative variables were expressed in absolute frequency and percentage relative frequency. Quantitative variables were expressed as mean and standard deviation. The normality of the distribution was verified using the Kolmogorov Smirnov test. Results: Of a total of 57 patients, the mean age was 59 ± 12.8 years, female sex 64.9%. Presenting 22.8% poor knowledge of the disease. Regarding the control of BP figures, 31.6% reported not checking regularly. Adherence to pharmacological treatment at the beginning of the monitoring was 33.3%. Figures lower than those described by RENATA-2, where half of the treated hypertensives complied with the treatment. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed at the beginning and end of the study. Pre-monitoring measurements were mean SBP: 138.6 ± 17.8 mmHg and mean DBP: 85.4 ± 14.8 mmHg. The records at the end of the immediate monitoring were 131.5 ± 19.9 mmHg and 81.5 ± 14.2 mmHg for PAS and PAD, respectively. Finding a significant difference between the means of the PAS (p 0.019), but not between the means of the DBP (p 0.06). Discussion: Although the percentage of patients achieving good BP control was significant, these results may be closely related to a subtype of observed performance bias, rather than the outcome of the intervention. The mean days of telemonitoring were 8, 85, number of shots was 34.12, and number of interventions performed by the observer (medication change) was 0.30. User satisfaction with the method used was 96.4%, and 100% considered it Easy or very easy to use. 87.5% would use it for long periods of time, including older adults. Conclusions: The studied method shows potential benefits for the control of BP figures, with a wide acceptance by users, facilitating access to the health system, and quality medical care.

Introdução: A hipertensão arterial é o grande desafio das políticas de saúde no mundo. Sua alta prevalência, o descontrole (ligado à baixa adesão ao tratamento anti-hipertensivo) e sua alta "carga" (como doença não transmissível) são responsáveis ​​pelo aumento da morbimortalidade cardiovascular. Objetivo: foi avaliar como teste piloto, o benefício do telemonitoramento em tempo real, aplicado ao controle da pressão arterial (PA). Metodologia: Critérios de inclusão: Hipertensos diagnosticados, em tratamento farmacológico, atendidos na policlínica do Hospital Maciel no período de junho a outubro de 2019. Critérios de exclusão: gravidez e circunferência do braço menor que 22 cm ou maior que 42 cm. Foi implementado o monitoramento domiciliar da pressão arterial, utilizando um monitor eletrônico de pressão arterial validado e um telefone celular inteligente conectado a uma plataforma web privada em tempo real. Estudo analítico, experimental, prospectivo.As variáveis ​​qualitativas foram expressas em frequência absoluta e frequência relativa percentual. As variáveis ​​quantitativas foram expressas como média e desvio padrão. A normalidade da distribuição foi verificada por meio do teste de Kolmogorov Smirnov. Resultados: De um total de 57 pacientes, a média de idade foi de 59 ± 12,8 anos, sexo feminino 64,9%. Apresentando 22,8% conhecimento ruim sobre a doença. Em relação ao controle dos valores da PA, 31,6% relataram não verificar regularmente. A adesão ao tratamento farmacológico no início do acompanhamento foi de 33,3%, valores inferiores aos descritos pelo RENATA-2, onde metade dos hipertensos tratados aderiu ao tratamento. A pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD) foram analisadas no início e no final do estudo. As medições de pré-monitoramento foram PAS média: 138,6 ± 17,8 mmHg e PAD média: 85,4 ± 14,8 mmHg. Os registros ao final do monitoramento imediato foram de 131,5 ± 19,9 mmHg e 81,5 ± 14,2 mmHg para PAS e PAD, respectivamente. Encontrando diferença significativa entre as médias do PAS (p 0,019), mas não entre as médias do DBP (p 0,06). Discussão: Embora a porcentagem de pacientes que alcançaram um bom controle da PA tenha sido significativa, esses resultados podem estar intimamente relacionados a um subtipo de viés de desempenho observado, e não ao resultado da intervenção. A média de dias de telemonitoramento foi 8, 85, o número de disparos foi 34,12, e o número de intervenções realizadas pelo observador (mudança de medicação) foi de 0,30. A satisfação dos usuários com o método utilizado foi de 96,4%, sendo que 100% consideraram fácil ou muito fácil de usar. 87,5% usariam por longos períodos de tempo, inclusive idosos adultos. Conclusões: O método estudado apresenta potenciais benefícios para o controle dos valores da PA, com ampla aceitação pelos usuários, facilitando o acesso ao sistema de saúde e assistência médica de qualidade.

Investigating how clathrin adaptor complex AP-2 participates in Giardia lamblia encystation.

The protozoan parasite Giardia lamblia acquires cholesterol from the environment since it is unable to synthesise cholesterol de novo and this is vital for trophozoite growth. Conversely, the lack of cholesterol was described as an essential event to trigger encystation, the differentiation of trophozoites to mature cysts. During the G. lamblia cell cycle, cholesterol is acquired as a free molecule as well as through receptor-mediated endocytosis (RME) of lipoproteins. In this work, we describe the involvement of RME in the cell differentiation process of G. lamblia. We found that a reduction in the expression of the medium subunit (Glµ2) of the giardial adaptin protein GlAP2 impaired RME, triggering the process of encystation in growing cells. Contrary to expectations, decreasing Glµ2 expression produced a cohort of trophozoites that yielded significantly less mature cysts when cells were induced to encyst. Analysis of the subcellular localization of Glµ2 and the cyst wall protein 1 (CWP1) during encystation was later performed, to dissect the process. Our results showed, on one hand, that blocking RME by inhibiting Glµ2 expression, and probably cholesterol entry, is sufficient to induce cell differentiation but not to complete the process of encystation. On the other hand, we observed that GlAP2 is necessary to accomplish the final steps of encystation by sorting CWP1 to the plasma membrane for cyst wall formation. The understanding of the mechanisms involved in cyst formation should provide novel insights into the control of giardiasis, an endemic worldwide neglected disease.

Enterobiasis and its risk factors in urban, rural and indigenous children of subtropical Argentina.

A cross-sectional survey to assess the prevalence of Enterobius vermicularis infection and its associated factors among the child population of infant, preschool and school age in the urban, rural and indigenous population of Iguazú city, in subtropical Argentina was presented. Additionally, the status of enterobiasis at country level was reviewed and analysed. Enterobius vermicularis presence was assessed employing an oviscopic serial sampling technique. Statistical analysis of socio-demographic determinants was performed by generalized linear mixed models at individual, household and community levels. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to gather national information about E. vermicularis prevalence spanning the decade 2010­2020. A total of 916 children from 470 families participated. Overall prevalence was 29.8%, with 25.3, 30.7 and 34.2% detected for children inhabiting urban, rural and indigenous villages, respectively. The multi-level analysis showed that the presence of E. vermicularis was mostly determined by individual (e.g. age, playing habits, previous pinworm infection) and household-level factors (e.g. family size, overcrowding conditions). Interestingly, WASH variables, such as waste disposal, analysed at community level were also important. Data were analysed to provide eco-epidemiological features of enterobiasis in a heterogeneous subtropical child population in the same territory but with different socio-sanitary realities. The importance of promoting multi-level actions against the determinants identified, to control this public health problem integratively was evidenced. The scoping review of national data updated the state of knowledge of this parasitosis, identifying risk determinants and gaps in knowledge at country level.

A voyage to Argentina: the Asuero case and the illegal practice of medicine (Buenos Aires, 1930). / Un viaje a la Argentina: el caso Asuero y la práctica ilegal de la medicina (Buenos Aires, 1930).

This article examines the activities of a well-known figure who, during his stay in Argentina, influenced life in Buenos Aires by cultivating his connections to medical science, the political sphere and the news media. The person in question was Fernando Asuero, an ear, nose and throat specialist from San Sebastián (Spain), whose activities in Buenos Aires in 1930 allow us to examine the conflicts within the healing arts, a field rife with competitors and numerous concurrent and opposing traditions. Using a biographical approach centered on a case study, this article shows that, at certain points, the disputes over cognitive monopoly ended up being debated within a courtroom.

Indagamos el derrotero de un personaje que, durante su estadía en Argentina, incidió en la vida porteña mediante los vínculos que trazó con la ciencia galénica, la esfera política y los medios de comunicación. Nos referimos a Fernando Asuero, especialista en nariz, garganta y oídos, oriundo de San Sebastián (España), figura cuyo itinerario por Buenos Aires en 1930 nos permite avizorar enfrentamientos propios del arte de curar, campo minado de competidores y cuantiosas tradiciones concomitantes y contrapuestas. A partir de una aproximación biográfica centrada en un estudio de caso mostraremos que, en ciertas oportunidades, los litigios imbricados al monopolio cognitivo terminaron por debatirse en el interior de un juzgado.

Un viaje a la Argentina: el caso Asuero y la práctica ilegal de la medicina (Buenos Aires, 1930) / A voyage to Argentina: the Asuero case and the illegal practice of medicine (Buenos Aires, 1930)

Resumen Indagamos el derrotero de un personaje que, durante su estadía en Argentina, incidió en la vida porteña mediante los vínculos que trazó con la ciencia galénica, la esfera política y los medios de comunicación. Nos referimos a Fernando Asuero, especialista en nariz, garganta y oídos, oriundo de San Sebastián (España), figura cuyo itinerario por Buenos Aires en 1930 nos permite avizorar enfrentamientos propios del arte de curar, campo minado de competidores y cuantiosas tradiciones concomitantes y contrapuestas. A partir de una aproximación biográfica centrada en un estudio de caso mostraremos que, en ciertas oportunidades, los litigios imbricados al monopolio cognitivo terminaron por debatirse en el interior de un juzgado.

Abstract This article examines the activities of a well-known figure who, during his stay in Argentina, influenced life in Buenos Aires by cultivating his connections to medical science, the political sphere and the news media. The person in question was Fernando Asuero, an ear, nose and throat specialist from San Sebastián (Spain), whose activities in Buenos Aires in 1930 allow us to examine the conflicts within the healing arts, a field rife with competitors and numerous concurrent and opposing traditions. Using a biographical approach centered on a case study, this article shows that, at certain points, the disputes over cognitive monopoly ended up being debated within a courtroom.

Determinantes sociales de la salud asociados a la severidad y mortalidad en pacientes con COVID-19 / Social determinants of health associated with severity and mortality in patients with COVID-19

Resumen Introducción: Históricamente, las pandemias han tenido como resultado tasas de mortalidad más altas en las poblaciones más vulnerables. Los determinantes sociales de la salud (DSS) se han asociado a la morbimortalidad de las personas en diferentes niveles. Objetivo: Determinar la relación entre los DSS, la severidad de COVID-19 y la mortalidad por esta enfermedad. Métodos: Estudio retrospectivo en el que se recolectaron datos de pacientes con COVID-19 en un hospital público de Chile. Las variables sociodemográficas relacionadas con los DSS estructurales se clasificaron según las siguientes categorías: sexo, edad (< 65 años, ≥ 65 años), educación secundaria (completada o no), condición de trabajo (activo, inactivo) e ingreso económico (< USD 320, ≥ USD 320). Resultados: Fueron incluidos 1012 casos con COVID-19 confirmados por laboratorio. La edad promedio fue de 64.2 ± 17.5 años. La mortalidad de la muestra total fue de 14.5 %. La edad, nivel educativo, desempleo e ingresos tuvieron fuerte asociación con la mortalidad (p < 0.001). Conclusiones: Los hallazgos refuerzan la idea de que los DSS deben considerarse una prioridad de salud pública, por lo que los esfuerzos políticos deben centrarse en reducir las desigualdades en salud para las generaciones futuras.

Abstract Introduction: Historically, pandemics have resulted in higher mortality rates in the most vulnerable populations. Social determinants of health (SDH) have been associated with people morbidity and mortality at different levels. Objective: To determine the relationship between SDH and COVID-19 severity and mortality. Methods: Retrospective study, where data from patients with COVID-19 were collected at a public hospital in Chile. Sociodemographic variables related to structural SDH were classified according to the following categories: gender, age (< 65 years, ≥ 65 years), secondary education (completed or not), work status (active, inactive) and income (< USD 320, ≥ USD 320). Results: A total of 1,012 laboratory-confirmed COVID-19 cases were included. Average age was 64.2 ± 17.5 years. Mortality of the entire sample was 14.5 %. Age, level of education, unemployment and income had a strong association with mortality (p < 0.001). Conclusions: The findings reinforce the idea that SDH should be considered a public health priority, which is why political efforts should focus on reducing health inequalities for future generations.

Un viaje a la Argentina: el caso Asuero y la práctica ilegal de la medicina(Buenos Aires, 1930) / A voyage to Argentina: the Asuero case and the illegal practice of medicine (Buenos Aires, 1930)

Indagamos el derrotero de un personaje que, durante su estadía en Argentina, incidió en la vida porteña mediante los vínculos que trazó con la ciencia galénica, la esfera política y los medios de comunicación. Nos referimos a Fernando Asuero, especialista en nariz, garganta y oídos, oriundo de San Sebastián (España), figura cuyo itinerario por Buenos Aires en 1930 nos permite avizorar enfrentamientos propios del arte de curar, campo minado de competidores y cuantiosas tradiciones concomitantes y contrapuestas. A partir de una aproximación biográfica centrada en un estudio de caso mostraremos que, en ciertas oportunidades, los litigios imbricados al monopolio cognitivo terminaron por debatirse en el interior de un juzgado.(AU)

Hipertensión arterial y dislipemia / Arterial hypertension and dyslipidemia / Hipertensão arterial e dislipidemia

Resumen: Introducción: la enfermedad cardiovascular representa mundialmente la principal causa de muerte resultando imprescindible entonces un abordaje multifactorial mediante el cálculo del riesgo cardiovascular (RCV). Múltiples series a nivel mundial han demostrado una alta asociación entre hipertensión arterial (HTA) y dislipemia, en algunas superiores al 50%. El objetivo de este estudio es determinar la asociación entre ambas variables con el fin de profundizar en la estratificación de riesgo del paciente hipertenso. Materiales y métodos: se realizó un estudio analítico, observacional, de tipo transversal, que incluyó a todos los pacientes que asistieron a la policlínica de HTA de nuestro centro entre el 2 de marzo de 2015 y el 2 de octubre de 2019 inclusive. Resultados: se incluyeron 103 pacientes. El 75,7% (n=78) presentó dislipemia. Se destaca que el 68,9% (n=71) presenta HTA nocturna. Se estableció una asociación estadísticamente significativa entre dislipemia e HTA nocturna, con OR=3,364. En cuanto al perfil lipídico, predomina la dislipemia mixta en un 37,9% (n=39). Conclusiones: existe una alta relación entre HTA y dislipemia. La HTA nocturna y el patrón non dipper asocian mayor RCV.

Summary: Introduction: cardiovascular disease represents the main cause of death worldwide. A multifactorial approach is essential, by calculating cardiovascular risk. Series worldwide have shown a high association between hypertension and dyslipidemia, in some of them higher than 50%. Our objective is to determine the association between both variables in order to improve the risk stratification of the hypertensive patient. Materials and methods: an analytical, observational, cross-sectional study was carried out, which included all the patients who attended the hypertension polyclinic between March 2, 2015 and October 2, 2019 inclusive. Results: 75.7% (n=78) of the patients presented dyslipidemia. It is noteworthy that 68.9% (n=71) have nocturnal hypertension. A statistically significant association between dyslipidemia and nocturnal hypertension was established, with an OR=3.364. Regarding the lipid profile, mixed dyslipidemia predominates in 37.9%. Conclusions: there is a high relationship between hypertension and dyslipidemia. Nocturnal hypertension and the non-dipper pattern are associated with cardiovascular risk.

Resumo: Introdução: as doenças cardiovasculares representam a principal causa de morte no mundo. Uma abordagem multifatorial é essencial, calculando o risco cardiovascular. As séries em todo o mundo demonstraram uma alta associação entre hipertensão e dislipidemia, em alguns superiores a 50%. Nosso objetivo é determinar a associação entre as duas variáveis, a fim de melhorar a estratificação de risco do paciente hipertenso. Materiais e métodos: foi realizado um estudo analítico, observacional e transversal, que incluiu todos os pacientes que compareceram à policlínica hipertensão entre 2 de março de 2015 e 2 de outubro de 2019 inclusive. Resultados: 75,7% (n=78) dos pacientes apresentaram dislipidemia. Vale ressaltar que 68,9% (n=71) possuem hipertensão noturna. Foi estabelecida associação estatisticamente significante entre dislipidemia e hipertensão noturna, com OR=3,364. Quanto ao perfil lipídico, a dislipidemia mista predomina em 37,9%. Conclusões: existe uma alta relação entre hipertensão e dislipidemia. A hipertensão noturna e o padrão non dipper estão associados ao risco cardiovascular.

Giardia spp., the most ubiquitous protozoan parasite in Argentina: human, animal and environmental surveys reported in the last 40 years.

Giardia is a parasite distributed worldwide and one of the most prevalent intestinal protozoa in Argentina. We analysed all the national information regarding the prevalence of Giardia infections in humans, animals and environmental surveys over the last 40 years. In this work, we used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the period between 1980 and 2019 was defined as time lapse for inclusion of the studies. The analysis was conducted using the LILACS, PubMed, Scopus and Argentina SciELO databases employing as keywords 'Giardia' AND 'Argentina'. We also carried out a manual review of papers. Of 304 articles, 92 fitted the eligibility criteria. Giardia was reported in 15 of the 23 Argentine provinces; human prevalence was between 3.4 and 64.8%. Indigenous children and residents in peri-urban areas had the higher infection rates. In animals, Giardia was identified mainly in dogs with a prevalence of 8.9 ± 7.0%, and studies of wild animals and cattle were notably scarce. Environmental studies showed that Giardia was detected in the soil and water which may act as reservoirs for this parasite revealing the need to modify the national water treatment legislation. The identification of Giardia genetic assemblages in the studies analysed was limited and showed that genotypes AII and B were found in humans while assemblage B was mainly detected in animals. This report provides useful information on epidemiological aspects of giardiasis in Argentina that may help to define future research priorities and provides useful tools for professionals regarding actual information on the prevalence of this infection.

La enfermedad en imágenes: representaciones de la gripe española en la prensa argentina (1918) / The disease in images: representations of the spanish flu in the argentine press (1918)

Resumen La gripe española, pese a ser una epidemia olvidada en Argentina, suscitó un fuerte impacto, tanto en la tasa de mortalidad del territorio nacional como en variados aspectos de la vida social, política, cultural y económica del país. En ese sentido, si bien se han realizado estudios desde perspectivas notoriamente enriquecedoras, no se ha planteado un abordaje que recupere las representaciones que realizaron, durante el brote, periódicos y revistas de circulación masiva. A partir de ese vacío historiográfico, el presente estudio pretende realizar un análisis de caricaturas e historietas colocadas en la reconocida revista argentina Caras y Caretas, intentando arrojar luz acerca de las diferentes formas en que la dolencia era presentada a su profuso público. El análisis, según lo venimos anticipando, nos lleva a proponer un abordaje anclado en una metodología de trabajo fundamentalmente cualitativa, definida a partir de la articulación del análisis histórico hermenéutico y del estudio de contenido, recuperando para este último algunas herramientas que nos otorga la sociosemiótica. Se trabajará sobre un conjunto de imágenes seleccionadas a partir de su contenido, en términos de los datos que arrojan sobre las condiciones de producción del discurso.

Abstract The spanish flu, despite being an epidemic forgotten in Argentina, caused a strong impact, both in the mortality rate of the national territory and in various aspects of the social, political, cultural and economic life of the country. In this sense, although there have been studies from notoriously enriching perspectives, an approach has not been proposed that recovers the representations made, during the outbreak, by newspapers and magazines of mass circulation. From this historiographical vacuum, this study aims to perform an analysis of cartoons and comics placed in the renowned argentine publishing house "Caras y Caretas", trying to shed light on the different ways in which the disease was presented by the magazine to its profuse public consumer. The analyse, as we have been anticipating, leads us to propose an approach anchored in a fundamentally qualitative work methodology, defined from the articulation of the hermeneutical historical analysis and the content study, recovering for the latter some tools that the socioemiotic gives us. Work will be done on a set of images selected from their content, in terms of the data they give about the conditions of speech production.

Substantial reduction in child stunting is differentially associated to geographical and socioeconomic disparities in Misiones Province, Argentina.

OBJECTIVE: To estimate trends in the prevalence of child stunting in the population of children under 5 years of age covered by public health programmes, between 2009 and 2014 in Misiones, Argentina. METHODS: Using Bayesian model-based geostatistics, we evaluated 724 872 anthropometric measurements corresponding to 110 633 children. In order to identify disparities at local scale, we evaluated the hypotheses of a differential reduction of stunting according to the geographical location (at two-level spatial resolution) and to the socioeconomic level in a rural or urban environment. RESULTS: The prevalence of stunting had fallen significantly in the province overall. Sex and age defined gender disparities at individual level, and there were regional disparities with higher prevalence values in the north and northeast regions. In these areas, stunting decreased to a greater degree during the studied period, although the spatial pattern remained smoother. Stunting increased in peripheral urban and dispersed rural areas that are socioeconomically vulnerable. CONCLUSIONS: The spatial multi-level geostatistical estimates of child undernutrition provide a precision public health tool to target public policies to those populations with the greatest need, in order to reduce health disparities.

OBJECTIF: Estimer les tendances dans la prévalence du retard de croissance dans la population des enfants de moins de 5 ans couverts par les programmes de santé publique, entre 2009 et 2014 à Misiones, en Argentine. MÉTHODES: En utilisant la géostatistique basée sur un modèle bayésien, nous avons évalué 724.872 mesures anthropométriques correspondant à 110.633 enfants. Afin d'identifier les disparités à l'échelle locale, nous avons évalué les hypothèses d'une réduction différentielle du retard de croissance en fonction de la situation géographique (à une résolution spatiale à deux niveaux) et du niveau socioéconomique en milieu rural ou urbain. RÉSULTATS: La prévalence du retard de croissance avait considérablement diminué dans l'ensemble de la province. Le sexe et l'âge définissaient des disparités entre les sexes au niveau individuel, et il y avait des disparités régionales avec des valeurs de prévalence plus élevées dans les régions du nord et du nord-est. Dans ces régions, le retard de croissance a diminué plus fortement au cours de la période étudiée, bien que le modèle spatial soit resté plus lisse. Le retard de croissance a augmenté dans les zones urbaines périphériques et les zones rurales dispersées qui sont socioéconomiquement vulnérables. CONCLUSIONS: Les estimations géostatistiques spatiales à plusieurs niveaux de la sous-nutrition infantile fournissent un outil de santé publique de précision pour cibler les politiques publiques sur les populations qui en ont le plus besoin, afin de réduire les disparités en matière de santé.

Twice upon a time: The progression of canine visceral leishmaniasis in an Argentinean city.

Canine Visceral Leishmaniasis (CVL) prevalence, spatial distribution and associated factors were assessed in four locations in Iguazú department in 2014 and in Puerto Iguazú city again in 2018. The city areas were divided into a grid of 400x400m cells. All cells were sampled in 2014 and a random subsampling was developed in 2018. In each cell, five dogs clustered in a 'critical scenario' (prone to have vectors) were sampled. A rapid immunochromatographic dipstick was used to detect antibodies against Leishmania infantum, confirming by lymph node smears observation and PCR. For Puerto Iguazú, Generalized Linear Models (GLMs) were constructed considering environmental, dog and clinical variables. Pearson's Chi square and Fisher's exact tests were employed to evaluate the association between CVL, dog clinical signs and infestation with other parasites. Cartographic outputs were made and Moran's I indices were calculated as spatial autocorrelation indicators. CVL prevalence rates were 26.18% in 2014 and 17.50% in 2018. No associations were established in environmental models, but dog age and repellent use were significant when running 2014 dog models. Clinical models showed significant associations between seropositive dogs and ophthalmological, dermal signs and onychogryphosis in 2014. In 2018, only adenomegaly was associated. The results of global Moran´s I were not significant but regarding local analysis, six sites in 2014 and one in 2018 presented autocorrelation with neighboring sites. The decrease in CVL prevalence may be associated to transmission stabilization, which could explain the lack of associations with dog-related variables. Further, spatial distribution of CVL is a poor evidence for design of transmission control measures but could be important in case of intensive parasite circulation or when the first autochthonous cases appear. For control success, sensitivity of diagnostic methods, political will and adequate material resources remain critical. Modeling of multiple variables will be required to identify factors that drive disease stabilization/destabilization.

Flow cytometry evaluation of in vitro susceptibility of bovine isolates of Tritrichomonas foetus to metronidazole.

Bovine Trichomonosis, an endemic sexually transmitted disease in countries with extensive livestock and natural service, represents one of the most common causes of reproductive failure. 5-nitroimidazoles and their derivatives are used for its treatment, mainly metronidazole (Mz). The emergence of resistance mechanisms adopted by the parasites against the drug and failure of the treatments suggest the need to investigate susceptibility and obtain current values. The available information of in vitro susceptibility of these drugs comes from the use of a diversity of methodologies and criteria, especially observation of the mobility of the parasite under the optical microscope to evaluate its viability. These techniques are arduous and time consuming and lead to a subjective assessment dependent on the operator, the methodology used, and the morphology adopted by the protozoan. In this sense, flow cytometry has proven to be a fast and efficient method to evaluate viability in other protozoa. The aim of this study was to evaluate the in vitro susceptibility of six bovine isolates of Tritrichomonas foetus to Mz in aerobic (AC) and anaerobic (ANC) conditions by means of the calculation of the 50% inhibitory concentration (IC50), by flow cytometry, and also to analyze minimum lethal concentration (MLC) by means of recovery tests post-treatment in vitro. IC50 values ranged from 1.06 to 1.25 µM in ANC and from 1.44 to 3.03 µM in AC, these being the only ones reported at 48 h for these protozoa. With respect to MLC at 48 h, the results were from 3.67 to 7.35 µM in ANC, and from 7.35 to 14.7 µM for AC, where two isolates (Tf0 and Tf2) for AC and one (Tf2) for ANC showed higher values than those described in the literature. Flow cytometry has proven to be an effective, rapid and objective methodology and very useful in susceptibility tests. The data obtained through these tests allow us to describe the susceptibility exhibited by these protozoa, this being valuable information when establishing dosages in Mz treatments.

In Vitro Susceptibility to Metronidazole of Tritrichomonas foetus Bovine Isolates from Argentina.

BACKGROUND: Tritrichomonas foetus is the etiologic agent of the sexually transmitted disease Bovine Trichomonosis (BT). In Argentina, BT is endemic and represents a relevant health problem that causes reproductive inefficiency in cattle and large economic losses. Metronidazole is the drug of choice in the treatment of BT. Treatment has been associated with a temporary resolution of the clinical signs but is not able to control the disease. In recent years, the apparition of in vivo and in vitro aerobic and anaerobic resistance leading to ineffective treatments has been reported. AIMS: Thus, the aim of the present study was to explore the susceptibility of six different isolates of T. foetus under aerobic (AC) and anaerobic (ANC) conditions. RESULTS AND DISCUSSION: Six isolates of T. foetus were obtained from samples of preputial smegma of bovine origin. Values of minimum lethal concentration and minimum inhibitory concentration were higher than those observed in other works and represent current data in Argentina and provide information to establish new treatment protocols.