Wash Your Hands... Save Lives!!!

Introducción: El lavado de manos es la medida de higiene que consiste en la eliminación mediante el arrastre de la flora presente de manera transitoria en la piel de las manos. Se considera una de las medidas más eficaces de la prevención y control de la transmisión de enfermedades infecciosas dentro del ámbito hospitalario. También para prevenir el contagio por COVID-19. Objetivos: Prevenir la propagación de patologías infecciosas en la población a través del lavado de mano, disminuir el número de microorganismos en las manos, reducir el riesgo de transmisión cruzada entre pacientes, controlar el nesgo de infección entre trabajadores sanitarios y evitar el riesgo de transmisión de infección a uno mismo.Introduction: Hand washing is the hygiene measure that consists in the elimination by means of the dragging of the flora present temporarily on the skin of the hands it is considered one of the most effective measures for the prevention and control of the transmission of infectious diseases within the hospital environment. Also to prevent the spread of COVID-19 Objectives: Prevent the spread of infectious diseases in the population through hand washing, reduce the number of microorganisms on the hands, reduce the risk of cross-transmission between patients, control the nsk of infection between health workers and avoid the risk of transmission of infection to oneself.Facultad de Odontologí

Disproportionate Intrauterine Growth Intervention Trial At Term: DIGITAT

Contains fulltext : 65628.pdf ( ) (Open Access)BACKGROUND: Around 80% of intrauterine growth restricted (IUGR) infants are born at term. They have an increase in perinatal mortality and morbidity including behavioral problems, minor developmental delay and spastic cerebral palsy. Management is controversial, in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance. We propose a randomised trial to compare effectiveness, costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term. METHODS/DESIGN: The proposed trial is a multi-centre randomised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36+0 and 41+0 weeks. After informed consent women will be randomly allocated to either induction of labour or expectant management with maternal and fetal monitoring. Randomisation will be web-based. The primary outcome measure will be a composite neonatal morbidity and mortality. Secondary outcomes will be severe maternal morbidity, maternal quality of life and costs. Moreover, we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry (Child Behavioral Check List-CBCL and Ages and Stages Questionnaire-ASQ). Analysis will be by intention to treat. Quality of life analysis and a preference study will also be performed in the same study population. Health technology assessment with an economic analysis is part of this so called Digitat trial (Disproportionate Intrauterine Growth Intervention Trial At Term). The study aims to include 325 patients per arm. DISCUSSION: This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality, costs and maternal quality of life aspects. This will be the first randomised trial for IUGR at term. TRIAL REGISTRATION: Dutch Trial Register and ISRCTN-Register: ISRCTN10363217

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Educación odontológica y concientización de las normas de bioseguridad en tiempos de pandemia

Introducción: Este proyecto tiene como propósito disminuir el riesgo de contaminación cruzada tanto en los trabajadores de la salud de diferentes centros de Atención Primaria, como así también en los individuos de la comunidad, contribuyendo a la concientización a la población y la vigilancia permanente de aplicación de las medidas de Bioseguridad. Nuestras acciones en el marco de la Pandemia Covid-19, estarán orientadas, a lograr actitudes y conductas responsables, que disminuyan la posibilidad de adquirir infecciones. Será muy importante la educación continua sobre las medidas de protección y su correcta aplicación de las mismas. Objetivos: incorporar conocimientos, y capacitar en el manejo preventivo frente a los microorganismos potencialmente patógenos con poder de riesgo de contaminación biológica como lo es el virus Sars-COV2.Facultad de Odontologí

¡Cuidémonos entre todos! Parte II : Bioseguridad y educación odontológica en tiempos de pandemia COVID-19

Introducción: El COVID-19, se ha convertido en uno de los grandes enemigos de la humanidad en la actualidad. Se entiende por intervención en los centros de salud, ONG y/o clubes, la propuesta de herramientas que fomenten un cambio de conducta para minimizar las posibilidades de contagio y concientizar a la comunidad de los riesgos patogénicos cotidianos que se presentan en ámbitos de concurrencia masiva. Es de vital importancia la bioseguridad, ya que se encarga de evitar el riesgo para la salud y el medio ambiente proveniente de la exposición a agentes biológicos causantes de enfermedades. Nuestras acciones en el marco de la Pandemia Covid-19, fueron orientadas a lograr actitudes y conductas responsables, que disminuyan la posibilidad de adquirir infecciones.Facultad de Odontologí

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Il partenariato pubblico privato: il project financing in ambito Difesa

Com’è noto, lo Stato negli anni ha sempre impiegato, e tuttora impiega, numerosi e diversi schemi contrattuali con l’obiettivo di promuovere opere economicamente rilevanti, in particolar modo ricorrendo agli schemi più noti, nonché più antichi, dell’appalto e delle concessioni. Tuttavia, con il passare del tempo e con l’evoluzione della tecnologia, l’esigenza di maggiori collaborazioni orizzontali tra cittadini e istituzioni, la limitata disponibilità di denaro pubblico e l’obbligo di dover rientrare negli standard europei, hanno indotto le amministrazioni a ricercare dei nuovi ed innovativi schemi che potessero “alleggerire” la pubblica amministrazione. Per far fronte a tali esigenze, la soluzione individuata è stata quella di ricorrere ad un peculiare istituto, ovvero il partenariato pubblico-privato, che rispondeva alla necessità del contributo di finanziamenti privati, soprattutto in virtù delle restrizioni di bilancio cui gli Stati devono far fronte, ma consentiva alle pubbliche amministrazioni anche di beneficiare delle conoscenze, abilità operative e metodi di funzionamento del settore privato all’interno del quadro pubblico. La stessa Commissione Europea, infatti, in una comunicazione sui “PPP” del 2005 rivolta agli Stati membri, ha sottolineato che “l’interesse per queste forme di associazione, generalmente chiamate partenariati pubblico-privati, è dovuto, in parte, ai vantaggi che le autorità pubbliche potrebbero trarre dal know-how del settore privato – soprattutto ai fini di un aumento dell’efficienza – e, in parte, ai vincoli dei bilanci pubblici” . Nel corso degli anni questo fenomeno ha assunto una crescente importanza nel nostro Paese, sia grazie al solido aggancio normativo ritrovato nel principio di sussidiarietà orizzontale di cui all’articolo 118, comma 4, della Costituzione, ma anche grazie alla vasta gamma di modelli di cooperazione a lungo termine tra le autorità pubbliche ed il settore privato, aventi tutti finalità pubbliche, tra cui poter scegliere. Tra le diverse tipologie contrattuali riconducibili alla categoria aperta e flessibile del PPP, il project financing (o “finanza di progetto”) rappresenta una delle principali modalità applicative di tale istituto a cui le amministrazioni pubbliche ricorrono per realizzare e finanziare opere di pubblica utilità. Nello specifico, il project financing rappresenta una particolare e complessa tecnica di finanziamento che permette, da un lato, all’amministrazione di realizzare un’opera pubblica (o di pubblica utilità) facendo affidamento principalmente o totalmente sul capitale privato, mentre dall’altro, consente ai finanziatori – tramite la gestione – non solo di recuperare quanto investito, ma anche di ottenere dei profitti; perciò, è chiaro che la ratio del project financing è quella di soddisfare un interesse rilevante della collettività, come la costruzione di importanti e strategiche dotazioni pubbliche, o l’erogazione di primari servizi (pubblici). La finanza di progetto, pur non configurando un autonomo istituto giuridico, si caratterizza infatti per attrarre maggiormente i partner privati, che si trovano nella posizione di poter sviluppare ed elaborare il progetto in tutte le sue forme e fasi, sin dalla progettazione preliminare. In questo modo il partner privato assume sin da subito la responsabilità tecnica del progetto e, conseguentemente, sarà anche più incentivato a scegliere questa forma di cooperazione con la pubblica amministrazione proprio perché investirà e assumerà il rischio imprenditoriale su una propria “idea”. Grazie a queste caratteristiche peculiari, negli anni il project financing è stato sempre più impiegando dalle amministrazioni, fino ad “approdare” nel mondo della Difesa, dove anche la società in-house del Ministero della Difesa, ovvero Difesa Servizi S.p.A., ha iniziato ad impiegare questo strumento per far fronte alle esigenze delle Forze Armate. Pertanto, il presente elaborato, dopo aver analizzato l’istituto del partenariato pubblico-privato e la figura del project financing, descrivendone di entrambi le origini, le diverse forme e tipologie, la procedura di gara, i vantaggi e criticità e, soprattutto, le differenze e le novità introdotte in materia dal nuovo Codice dei Contratti Pubblici (decreto legislativo n. 36 del 2023), intende porre l’accento su uno dei più importanti progetti seguiti interamente da Difesa Servizi S.p.A. in materia, ovvero la realizzazione e gestione, mediante un contratto di partenariato pubblico-privato, del Polo Strategico Nazionale. In particolare, il seguente lavoro vuole descrivere il progetto presentato e realizzato dal RTI costituito da Sogei S.p.A., TIM S.p.A., Leonardo S.p.A. e CDP Equity, basato sulla costruzione e la gestione di un cloud che potrà ospitare in sicurezza i dati ed i servizi critici e strategici delle amministrazioni centrali, Aziende Sanitarie Locali, principali amministrazioni locali. In relazione a tale progetto, infine, il presente lavoro intende evidenziare le criticità e soprattutto i vantaggi che le Forze Armate, in particolare la Marina Militare, potrebbero ottenere dall’impiego di questo istituto e anche proporre delle nuove modalità di impiego del project financing per far fronte alle esigenze, in particolare di natura logistica, della Forza Armata

Functional study of Mal de Río Cuarto virus encoded proteins in plant hosts

El virus del Mal de Río Cuarto (MRCV, Fijivirus, Reoviridae) causa la principal enfermedad del maíz en la Argentina. Este virus es capaz de replicar de manera persistente y no citopática en delfácidos (chicharritas) y en el floema de varias especies de gramíneas donde provoca síntomas severos y económicamente importantes. Nuestro trabajo anterior demostró que el MRCV es una especie viral independiente de las conocidas hasta el momento cuyo genoma está formado por 10 segmentos de RNA de doble cadena que codifican para 13 proteínas (PMRCVs) e identificó aquellas proteínas estructurales. Sin embargo, aún se desconoce la función de la mayoría de las proteínas virales (en particular de aquellas no estructurales) y los mecanismos moleculares que determinan el establecimiento y desarrollo de la infección. El objetivo general de esta Tesis fue estudiar, definir y caracterizar la función de distintas proteínas codificadas por el MRCV a nivel molecular en hospedantes vegetales. En particular se propuso identificar las proteínas virales implicadas en el movimiento intercelular del virus dentro de la planta, en la producción de los síntomas del MRCV en plantas (determinantes de patogenicidad) y la(s) posible(s) proteina(s) con actividad supresora del silenciamiento de RNA. Este trabajo de Tesis representa el primer avance en la caracterización a nivel molecular de la función de 10 las 13 PMRCVs (P4, P5-1, P5-2, P6, P7-1, P7-2, P8, P9-1, P9-2 y P10) en sistemas vegetales. Para identificar proteínas del MRCV responsables del movimiento viral en plantas, se ensayó la capacidad de las distintas proteínas en estudio de complementar el movimiento de un Potato virus X (PVX) mutante, defectivo en esta función en Nicotiana benthamiana (Nb). Mediante este sistema, no fue posible identificar proteínas de movimiento entre las codificadas por el MRCV. A continuación se analizaron las características de la infección de plantas de Nb con recombinantes de PVX portando distintas secuencias codificantes para las PMRCVs. Se encontró que la expresión temprana de la proteína no estructural P7-2 produce un drástico aumento en la severidad sintomática que no es acompañado por un aumento en la acumulación viral, mientras que la expresión de P7-1 a partir del mismo vector retrasa la infección viral y reduce la severidad sintomática. Por otra parte, la presencia de los secuencias codificantes para las proteínas P9-1 (mayoritaria del viroplasma) y P10 (mayoritaria de cápside externa) en el mismo vector viral impidió el establecimiento de la infección, sugieriendo que estas proteínas podrían desencadenar una respuesta de resistencia a la infección viral en Nb. Con el objetivo de identificar proteínas del MRCV con actividad supresora del silenciamiento del RNA se utilizó un sistema modelo que se basa en la inducción del silenciamiento en plantas transgénicas que expresan GFP mediante la agroinfiltración con una cepa capaz de expresar un inductor de silenciamiento (GFP o dsGFP). Ninguna de las proteínas del MRCV evaluadas logró interferir con el silenciamiento tanto local como sistémico en este sistema. Sin embargo, mediante el uso de este sistema modelo se logró demostrar que la expresión de las proteínas no estructurales P7-1 y P7-2 codificadas por el segmento 7 del MRCV da lugar a reducciones en la acumulación del mRNA de transgenes expresados de manera transitoria o estable en un proceso que probablemente sea de origen postranscripcional. Esta actividad no había sido descripta hasta el momento para otras proteínas virales y es muy novedosa e interesante, en particular cuando se considera que la proteína P7-2 no está presente en el virus Nilaparvata lugens reovirus (NLRV) que pertenece al mismo género que el MRCV pero que es incapaz de infectar plantas. En conjunto los resultados sugieren que las proteínas P7-1 y P7-2 podrían estar implicadas en la regulación de la expresión tanto de genes virales como del hospedante durante el desarrollo de la infección del MRCV. Finalmente, al estudiar la expresión transitoria de las PMRCVs en Nb se encontró que sus niveles de expresión son bajos y que la utilización de dicotiledóneas como sistemas modelo para el estudio funcional de estas proteínas podría no ser conveniente en ciertos casos. Al analizar comparativamente el uso de codones de las PMRCVs en Nb, maíz y Nilaparvata lugens (delfácido en el que replica el NLRV), no se encontraron diferecias en el uso de codones que pudieran explicar los bajos niveles de expresión en Nb. La información y herramientas biológicas aquí generadas constituyen un gran progreso en el estudio de la actividad de las proteínas coficadas por el MRCV lo cual contribuirá al diseño de futuras estrategias efectivas de control de esta enfermedad en plantas.Mal de Río Cuarto virus (MRCV, Fijivirus, Reoviridae) causes the most important maize disease in Argentina. This virus is able to replicate both in delphacid vectors (planthoppers) where it replicates in a persistent and non-cytopathic manner and in the phloem tissue of several grass species where it produces severe and economically important symptoms. Our previous work showed that MRCV is a new viral species and that its genome consists of 10 segments of double-stranded RNA that encode for 13 proteins (PMRCVs). The identity of the viral structural proteins was also defined. However, the biological function of the different PMRCVs (particularly in the case of non-structural proteins) and the mechanisms that determine the establishment and development of MRCV infection in both hosts are still unknown. The aim of this Thesis was to study, define and characterize the role of different MRCV-encoded proteins in plant hosts at a molecular level. Our particular goals were to identify those viral proteins involved in the virus spread within the plant, those involved in the development of MRCV symptoms in plants (pathogenicity determinants) and the possible viral RNA silencing suppressors. This Thesis represents the first general survey of the biological function at a molecular level of 10 of the 13 PMRCVs (P4, P5-1, P5-2, P6, P7-1, P7-2, P8, P9-1, P9-2 y P10) using plant model system. In order to identify those PMRCVs involved in plant intercellular movement, the capacity of different viral-encoded proteins to complement movement of a mutant Potato Virus X (PVX) in Nicotiana benthamiana (Nb) was assessed. Using this model system no movement protein was found amongst PMRCVs. Next, general features of infections caused by recombinant PVX viruses carrying PMRCVs-coding sequences in Nb were analyzed. It was found that the early expression of P7-2 causes a drastic increase in symptom severity without producing a concomitant increase in recombinant PVX accumulation. Expression of P7-1 from the same PVX vector, on the other hand, lead to a delay in the progress of viral infection and reduced symptom severity. Inoculation of Nb with PVX recombinant vectors harboring P9-1 (major viroplasm protein) or P10 (major outher capsid protein) coding sequences produced no infection, suggesting that these proteins might trigger a resistance response. With the aim of identifying viral suppressors of RNA silencing among PMRCVs, a model system based on the induction of RNA silencing in transgenic plants expressing GFP by agroinfiltration with a strain capable of expressing an inducer of silencing (GFP or dsGFP) was used. None of the analyzed PMRCVs interfered with local or systemic RNA silencing. However using this same model system it was found that the expression of non-structural proteins P7-1 and P7-1, both encoded by MRCV genomic segment 7, caused reductions in the accumulation of mRNA from trangenes either transiently or stably expressed in a process that most probably is of postrancriptional origin. This activity has not been described so far for other viral protein and is very novel and interesting, especially considering that P7-2 is not present in Nilaparvata lugens reovirus (NLRV), a Fijivirus that is unable to infect plants. Overall, the results suggest that P7-1 and P7-2 may be involved in regulating the expression of both viral and host genes during MRCV infection. Finally, upon studying the transient expression of PMRCVs in Nb it was shown that their expression levels are low and that the use of dicots species as model systems for the functional study of these proteins may not be appropriate in certain cases. Comparative analysis of the codon usage of PMRCVs in Nb, maize and Nilaparvata lugens (delphacid in which NLRV replicates), showed that the low levels of expression of PMRCVs in Nb cannot be explained by differences in codon usage between these species. The information and tools generated here represent an important advancement in the study of MRCV-coded activities that will in turn contribute to the development of effective long-term strategies for disease control in plants.Fil:Mongelli, Vanesa Claudia. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina

Development of a novel set of Gateway-compatible vectors for live imaging in insect cells

Insect genomics is a growing area of research. To exploit fully the genomic data that are being generated, high-throughput systems for the functional characterization of insect proteins and their interactomes are required. In this work, a Gateway-compatible vector set for expression of fluorescent fusion proteins in insect cells was developed. The vector set was designed to express a protein of interest fused to any of four different fluorescent proteins [green fluorescent protein (GFP), cyan fluorescent protein (CFP), yellow fluorescent protein (YFP) and mCherry] by either the C-terminal or the N-terminal ends. Additionally, a collection of organelle-specific fluorescent markers was assembled for colocalization with fluorescent recombinant proteins of interest. Moreover, the vector set was proven to be suitable for simultaneously detecting up to three proteins by multiple labelling. The use of the vector set was exemplified by defining the subcellular distribution of Mal de Río Cuarto virus (MRCV) outer coat protein P10 and by analysing the in vivo self-interaction of the MRCV viroplasm matrix protein P9-1 in Förster resonance energy transfer (FRET) experiments. In conclusion, we have developed a valuable tool for high-throughput studies of protein subcellular localization that will aid in the elucidation of the function of newly described insect and virus proteins.Instituto de BiotecnologíaFil: Maroniche, Guillermo Andrés. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; ArgentinaFil: Mongelli, Vanesa Claudia. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; ArgentinaFil: Alfonso, Victoria. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; ArgentinaFil: Llauger, Gabriela. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; ArgentinaFil: Taboga, Oscar Alberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; ArgentinaFil: Del Vas, Mariana. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; Argentin