Impact of a public health intervention for active surveillance and mitigation of SARS-CoV-2 in a district from Buenos Aires province, Argentina: a descriptive epidemiological study

Background The first case of SARS-CoV-2 was reported in Argentina on 3 March 2020. Measures to limit the spread of the virus were implemented, including complete lockdown (26 March). Nonetheless, the virus spread throughout the country, with a first peak of almost a million cases in October. On 30 November, the government's recommendation switched from social, preventive and compulsory isolation, to social, preventive and compulsory distancing. Objectives To describe a tailored public health strategy to mitigate the spread of SARS-CoV-2 and determine its behaviour in San Antonio de Areco district from Buenos Aires province (Argentina) through a private-public association. Design, setting and participants Surveillance of the virus was performed with the local healthcare system, through early identification of cases and the systematic study of each infected individual and contact, regardless of symptomatology, using telemedicine and a COVID-19-specific outpatient clinic. Real-time PCR was used for detection using both individual and pooled samples, with a 12-hour turnaround time. Results Up to 30 November, a total of 2426 suspected cases were analysed and 578 were confirmed. Surveillance of health personnel and at-risk populations proved effective, mitigating viral spread. Pooling samples allowed reduction of operator time, helped reduce costs, and allowed detection of both symptomatic and asymptomatic cases. Conclusion After 8 months of protocol implementation, the strategy to intensively survey groups at higher epidemiological risk and the systematic search for asymptomatic cases with the incorporation of pooled PCR for diagnosis, in combination with individual testing, is an efficient and viable option in populations with similar characteristics, in the frame of social isolation.Fil: Crudo, Favio. Fundación Mundo Sano; ArgentinaFil: Fernández, Mariana. Fundación Mundo Sano; ArgentinaFil: Rodríguez Fermepín, Marcelo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Fisiopatología y Bioquímica Clínica; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Entrocassi, Andrea Carolina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Fisiopatología y Bioquímica Clínica; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Cardone, Karina Angela. No especifíca;Fil: Spina Markmann, Fernando. No especifíca;Fil: Periago, Maria Victoria. Fundación Mundo Sano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Chuit, Roberto. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Abril, Marcelo Claudio. Fundación Mundo Sano; Argentin

Clima y salud en la Argentina: diagnóstico de situación 2018

Fil: Domínguez, Diana Analía. Servicio Meteorológico Nacional. Dirección Nacional de Ciencia e Innovación en Productos y Servicios. Dirección Central de Monitoreo del Clima; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Ciencias de la Atmósfera y los Océanos; Argentina.El presente diagnóstico de situación sobre Clima y Salud en Argentina fue realizado por la Mesa de Trabajo sobre Cambio Climático de la Secretaría de Gobierno de Salud. Se realizó un estudio de tipo descriptivo, en el cual se presenta por un lado el comportamiento de las variables meteorológicas y por otro, algunos eventos seleccionados en salud. Asimismo, se desarrolla el estado del conocimiento sobre la relación entre el clima y la salud en Argentina en el período comprendido entre los años 2005 y 2017. La descripción climática fue realizada por el Departamento de Climatología del Servicio Meteorológico Nacional (SMN). Las estadísticas se basan en valores medios (promedio) del periodo 1981-2010. Los efectos del clima sobre la salud humana fueron estudiados a partir de su clasificación en efectos directos e indirectos, entendiendo como efectos directos aquellos ocurridos a raíz de la ocurrencia de eventos meteorológicos extremos tales como olas de frío y calor, inundaciones, sequías y vientos fuertes. Para el análisis de estos eventos se realizó el análisis de la frecuencia y distribución espacial de los eventos extremos para el período 2005-2017. Para el estudio de las patologías sensible al clima se priorizaron las patologías más relevantes para ser descriptas en base a la evidencia científica. Se realizó una descripción de la evolución temporal de los casos entre 2005 y 2017, a partir de los datos obtenidos de la vigilancia clínica (a través del módulo C2 del SNVS). Por último se presentan las tendencias y retos que afrontará el sistema sanitario debido al cambio climático

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo