Clinical characteristics of vulnerable populations hospitalized and diagnosed with COVID-19 in Buenos Aires, Argentina

There is not in Argentina publications regarding the presentation of patients with COVID-19 requiring hospitalized and emergency care in vulnerable populations (lower incomes and less education tend at greater risk for poor health status and healthcare access), and it has few reports in developing countries. The objective is to determine whether in the care of vulnerable patients, to succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality. The study is a prospective cohort investigation of patients with lab-confirmed COVID-19, who required to any of the Health Centers response from April 8, 2020, to August 18, 2020. In Buenos Aires Metropolitan Area (AMBA), April 8, 2020 the virus was identified in patients hospitalized in the "Southeast Network" (SN), AMBA. SN covering an area of 661 square kilometers, with 1.8 million inhabitants residing in urban, and rural areas. A total of 14 health centers with different levels of care complexity provide care to patients in the region. The information of each patient with COVID-19 evaluated by SN, was incorporated in an Epidemiological Dashboard. The investigation was designed and reported with consideration of observational studies in epidemiology. We describe the hospitals presentation and care of persons who required SN response and were ultimately diagnosed with COVID-19. From April 8, 2020, to August 18, 2020, were included 1495 patients with lab-confirmed COVID-19 in SN. A total of 58% patients were men, and the mean age (SD) was 48.9 (15.59) years. Eighty one percent patients with pre-existing diseases, most frequent hypertension and diabetes, but hypertension, chronic lung disease, and cardiovascular disease presented higher risk. A total of 13% were hospitalized in Intensive Therapy Unit. The mortality of the cohort was 9.77%. Mortality was higher for patients aged 65 or more (OR 5.09), and for those had some pre-existing disease (OR 2.61). Our observations are consistent with reports demonstrating older persons, and those with comorbidities have the highest risk of mortality related to COVID-19. However, unlike other reports from developed or some developing countries, the mortality in our study is lower. This finding may be related to age of our cohort is younger than other published. Also, the health system was able to respond to the demand.Fil: Yacobitti, A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Otero, L.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Doldan Arrubarrena, V.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Arano, J.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Lage, S.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Silberman, M.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Zubieta, M.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Erbetta, I.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Danei, P.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Baeck, G.. Hospital Mi Pueblo; ArgentinaFil: Vallejos, V.. No especifíca;Fil: Cavalli, F.. No especifíca;Fil: Calderón, N.. Gobierno de la Provincia de Buenos Aires. Hospital Zonal General de Agudos Doctor Lucio Melendez.; ArgentinaFil: Di Gregorio, M.. Gobierno de la Provincia de Buenos Aires. Hospital Zonal General de Agudos Doctor Lucio Melendez.; ArgentinaFil: Hernandez, V.. Hospital Dr. Arturo Oñativia - Salta Capital.; ArgentinaFil: Bruno, D.. Hospital Dr. Arturo Oñativia - Salta Capital.; ArgentinaFil: Rodera, B.. Municipalidad de Quilmes (buenos Aires). Hospital Zonal General de Agudos Doctor Isidoro Iriarte.; ArgentinaFil: Macherett, I.. Municipalidad de Quilmes (buenos Aires). Hospital Zonal General de Agudos Doctor Isidoro Iriarte.; ArgentinaFil: Parisi, M.. Municipalidad de Quilmes (buenos Aires). Hospital Zonal General de Agudos Doctor Isidoro Iriarte.; ArgentinaFil: Gallastegui, M.. Municipalidad de Quilmes (buenos Aires). Hospital Zonal General de Agudos Doctor Isidoro Iriarte.; ArgentinaFil: Paz, A.. Municipalidad de Quilmes (buenos Aires). Hospital Sub Zonal Materno Infantil Doctor Eduardo Oller.; ArgentinaFil: Bernardi, R.. No especifíca;Fil: Azcárate, S.. Gobierno de la Provincia de Buenos Aires. Hospital Provincial Evita Pueblo.; ArgentinaFil: Hraste, A.. Gobierno de la Provincia de Buenos Aires. Hospital Provincial Evita Pueblo.; ArgentinaFil: Caridi, Délida Inés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; ArgentinaFil: Boechi, Leonardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; ArgentinaFil: Salgado, P.. Universidad de Buenos Aires. Rectorado. Instituto de Investigaciones en Salud Pública; ArgentinaFil: Kochen, Sara Silvia. Gobierno de la Provincia de Buenos Aires. Hospital de Alta Complejidad Cuenca Alta Doctor Nestor Carlos Kirchner.; Argentina. Universidad Nacional Arturo Jauretche; Argentina. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario

Introduction: COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. Methods: Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann\u2013Whitney U test for continuous variables. Results: A slight reduction ( 126.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop 1212% versus 123.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). Conclusions: Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts

Efficacy and safety of extracranial vein angioplasty in multiple sclerosis: A randomized clinical trial

Importance: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by restricted venous outflow from the brain and spinal cord. Whether this condition is associated with multiple sclerosis (MS) and whether venous percutaneous transluminal angioplasty (PTA) is beneficial in persons with MS and CCSVI is controversial. Objective: To determine the efficacy and safety of venous PTA in patients with MS and CCSVI. Design, Setting, and Participants: We analyzed 177 patients with relapsing-remitting MS; 62 were ineligible, including 47 (26.6%) who did not have CCSVI on color Doppler ultrasonography screening. A total of 115 patients were recruited in the study timeframe. All patients underwent a randomized, double-blind, sham-controlled, parallel-group trial in 6MS centers in Italy. The trial began in August 2012 and concluded in March 2016; data were analyzed from April 2016 to September 2016. The analysis was intention to treat. Interventions: Patients were randomly allocated (2:1) to either venous PTA or catheter venography without venous angioplasty (sham). Main Outcomes and Measures: Two primary end pointswere assessed at 12 months: (1) a composite functional measure (ie, walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity) and (2) a measure of new combined brain lesions on magnetic resonance imaging, including the proportion of lesion-free patients. Combined lesions included T1 gadolinium-enhancing lesions plus new or enlarged T2 lesions. Results: Of the included 115 patients with relapsing-remitting MS, 76 were allocated to the PTA group (45 female [59%]; mean [SD] age, 40.0 [10.3] years) and 39 to the sham group (29 female [74%]; mean [SD] age, 37.5 [10.6] years); 112 (97.4%) completed follow-up. No serious adverse events occurred. Flow restoration was achieved in 38 of 71 patients (54%) in the PTA group. The functional composite measure did not differ between the PTA and sham groups (41.7%vs 48.7%; odds ratio, 0.75; 95%CI, 0.34-1.68; P = .49). The mean (SD) number of combined lesions on magnetic resonance imaging at 6 to 12 months were 0.47 (1.19) in the PTA group vs 1.27 (2.65) in the sham group (mean ratio, 0.37; 95%CI, 0.15-0.91; P = .03: adjusted P = .09) and were 1.40 (4.21) in the PTA group vs 1.95 (3.73) in the sham group at 0 to 12 months (mean ratio, 0.72; 95%CI, 0.32-1.63; P = .45; adjusted P = .45). At follow-up after 6 to 12 months, 58 of 70 patients (83%) in the PTA group and 22 of 33 (67%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 2.64; 95%CI, 1.11-6.28; P = .03; adjusted P = .09). At 0 to 12 months, 46 of 73 patients (63.0%) in the PTA group and 18 of 37 (49%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 1.80; 95%CI, 0.81-4.01; P = .15; adjusted P = .30). Conclusion and Relevance: Venous PTA has proven to be a safe but largely ineffective technique; the treatment cannot be recommended in patients with MS

Caracterização e estudo de envelhecimento de isolador tipo pino em PEAD utilizado no setor elétrico

Exportado OPUSMade available in DSpace on 2019-08-13T19:11:54Z (GMT). No. of bitstreams: 1 tese___cynthia___fev_2015.pdf: 7350306 bytes, checksum: 3409f0d0fec22fafc3c3ab0aecee570c (MD5) Previous issue date: 11O estudo do comportamento do material polimérico utilizado na composição dos isoladores de rede elétrica é de fundamental importância para avaliar a vida útil dos mesmos, como também seu desempenho em diferentes condições ambientais. O estudo em questão avaliou o comportamento de isoladores poliméricos tipo pino (15kV) em poli(etileno) de alta densidade (PEAD), sob condições de envelhecimento acelerado. Foram utilizadas três câmaras de envelhecimento, sendo duas de intemperismo artificial (radiação, temperatura e umidade) e uma de estresse elétrico (tensão e umidade), onde essa última constitui um produto desse trabalho. Para uma das câmaras de intemperismo, utilizou-se como referência a norma ASTM G155 e, para a outra, foram estabelecidos parâmetros os mais próximos possíveis da condição de envelhecimento natural na região metropolitana de Belo Horizonte (ciclos de verão e inverno). A fim de avaliar o efeito do formato da amostra sobre o envelhecimento acelerado, utilizou-se corpos de prova no formato gravata borboleta, placas e o próprio isolador (tal qual usado em serviço). As amostras foram envelhecidas por 200, 1.000 e 2.000h. O escopo do trabalho incluiu o projeto, instalação e operação da câmara de estresse elétrico. As amostras antes e após envelhecimento acelerado foram caracterizadas pelas seguintes técnicas: inspeção visual, medida de hidrofobicidade, medida de corrente de fuga, reometria, espectroscopia de absorção molecular na região do infravermelho com transformada de Fourier (FTIR), microscopia eletrônica de varredura (MEV) com espectroscopia por dispersão de energia de raios-x (EDS), termogravimetria (TG), calorimetria exploratória diferencial (DSC), ensaio mecânico de tração e determinação da rigidez dielétrica. Os resultados indicaram comportamento diferenciado das amostras envelhecidas em função do método de envelhecimento aplicado e do formato das amostras. O estresse elétrico aplicado na câmara projetada para tal finalidade mostrou-se efetivo. Há fortes indícios que durante o envelhecimento acelerado, em todos os métodos aplicados, houve migração de aditivos para a superfície das amostras. Observou-se perda mais acentuada de hidrofobicidade nos isoladores a partir de 1.000h de envelhecimento e perda total da mesma em 2.000h. Por reometria obteve-se indícios da intensidade da degradação apontada por FTIR e, ainda, verificou-se mudança de comportamento reológico de amostras submetidas ao envelhecimento a partir de 1.000h. As análises por MEV/EDS identificaram os elementos químicos presentes na superfície das amostras e as alterações em sua topografia em função do tempo de envelhecimento. Por TG foi possível estimar o tempo de vida útil das amostras, considerando apenas o efeito da temperatura e atmosfera inerte de nitrogênio. A análise de OOT (temperatura onset de oxidação) por DSC indicou diferença na estabilidade oxidativa entre as amostras. Quanto à cristalinidade, dentro do intervalo de tempo avaliado, apresentou-se pouco significativa na avaliação do envelhecimento acelerado. Com relação ao ensaio de tração e de rigidez dielétrica, esses não pareceram indicados para avaliar amostras cuja degradação ainda esteja ao nível superficial. Dentre as técnicas aplicadas, identificou-se aquelas com potencial para aplicação no estudo da correlação entre envelhecimento natural e acelerado, são elas: medida de hidrofobicidade, OOT, índice de carbonila e medida de massa molar média. Esse trabalho traz como resultado inédito o projeto, a construção e operação de uma câmara de estresse elétrico para isoladores tipo pino ou pilar, executando e caracterizando amostras sob envelhecimento acelerado em diferentes formatos, incluindo o isolador como aplicado em serviço. Além disso, pela primeira vez, foram estabelecidos ciclos de intemperismo (verão e inverno) a fim de obter uma boa correlação entre as condições do ambiente externo e o artificial, com base em dados meteorológicos da região metropolitana de Belo Horizonte.The study of polymeric material behavior used in the composition of insulators of the electrical system has a fundamental importance in evaluating their lifetime, as well as their performance in different environmental conditions. The effect of polymeric insulators pin-shaped (15kV) of high density polyethylene (HDPE) under accelerated aging. Three aging chambers were used, two chambers of artificial weathering were used (radiation, temperature and humidity) and one of electric stress (voltage and humidity), where the last was projected and constructed in this work. The ASTM G155 was used as reference for one of the weathering chambers, and other parameters to natural aging conditions were established considering the metropolitan area of Belo Horizonte (summer and winter cycles). In order to evaluate the effect of accelerated aging on the sample-shaped were used in the tests sample bowtie-shaped, plates and insulator (as is used in service). The samples were aged at 200, 1,000 and 2,000h. The scope of work included the design, installation and operation of electrical stress chamber. The samples before and after accelerated aging, were characterized by the following techniques: visual inspection, hydrophobicity, leakage current measurement, rheometry, Fourier transform infrared spectrometry (FTIR), scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), thermogravimetry (TG), differential scanning calorimetry (DSC), mechanical tests and determination of dielectric strength. The results showed different behavior of the aged samples, due to the aging method applied and the sample shape. The electric stress applied to the chamber constructed was effective. There is strong evidence that during accelerated aging for all the methods applied, there was migration of additives to the surface of the samples. The loss of hydrophobicity in insulators with 1.000h of aging was more expressive and with 2.000h was total. Despite the leakage current measurement not shown significant results until 1.000h of accelerated aging, it is possible that it can contribute significantly in the evaluation from 2.000h, due to the loss of hydrophobicity. By rheometry was obtained evidence of degradation intensity, too indicated by FTIR. This technique showed that rheological behavior of samples subjected to aging with 1.000hs was altered. Analysis by SEM / EDS to evaluate the effect of aging on the topography of the sample, and to identify the chemical elements present on the sample surface. TG was used to estimate the lifetime of the samples, considering only the effect of temperature and nitrogen atmosphere. The OOT analysis (oxidation onset temperature) by DSC indicated a difference between the oxidative stability of the samples. The crystallinity, within the estimated time interval, showed insignificant in the evaluation of accelerated aging. The mechanical and electrical tests were not appropriated to evaluate samples with degradation still in superficial level. Among the techniques applied, those identified with potential for application in the study of the correlation between aging natural and accelerated are: measure hydrophobicity, OOT, carbonyl index and measure of average molar mass. This work has as unprecedented result: project, construction and operation of an electric stress chamber for insulating type pin or pillar, implementation and characterization of samples under accelerated aging in different shapes, including the insulator as applied in service. In addition, by first time, weathering cycles were established (summer and winter) in order to get a good correlation between the conditions of the natural and the artificial environment, based on meteorological data in the metropolitan region of Belo Horizonte

Osservatorio sulla dinamica economico-finanziaria delle imprese della filiera dell\u2019auto in Piemonte. Primo rapporto 1998-2001

rapporto Collana Monografie della Regione Piemont

Osservatorio sulla dinamica economico-finanziaria delle imprese della meccanica specializzata in Piemonte. Primo rapporto 1998-2001

Working Paper CERIS-CNR Serie Speciale 12/200