Tuberculosis in large urban conglomerates: Representations and experiences of teams regarding their approach in a program area of the City of Buenos Aires, Argentina

Introducción: la tuberculosis (TB) persiste como un importante problema de salud pública en Argentina con una concentración preocupante en grandes centros urbanos. El objetivo de este estudio es la recuperación de los sentidos y las prácticas del proceso de atención-cuidado de la TB por parte de profesionales en una red pública de servicios de salud de un gran conglomerado urbano. Metodología: se realizó un análisis exploratorio con enfoque cualitativo, a partir de entrevistas semiestructuradas a integrantes de equipos sanitarios en un hospital y en centros de salud de la Ciudad Autónoma de Buenos Aires (CABA). Resultados: se identificaron diferentes matices de sentido acerca de la complejidad en el abordaje de la TB, estos variaban de acuerdo con las características de los servicios y las personas con TB. Se describieron estrategias para el tratamiento de casos difíciles: disponer de equipos interdisciplinarios, involucrar a otros actores de salud y dialogar con organizaciones de la sociedad civil bajo un enfoque territorial. Conclusiones: el control de la problemática de la TB en los grandes conglomerados urbanos presenta amplios desafíos. Desde la perspectiva del personal sanitario, se observan coyunturas que requieren la adecuación de ciertas estrategias interventoras para dar una respuesta de manera integrada.Introduction: Tuberculosis (TB) persists as an important public health problem in Argentina with a worrying concentration in large urban centers. The objective of this study is to recover the meanings and practices of professionals from a public network of health services in a large urban conglomerate on the TB care-care process. Methods: An exploratory study with a qualitative approach was carried out, based on semi-structured interviews with members of the health teams of a hospital and health centers of the CABA. Results: It was identified that, from the perspective of the health teams, there are different nuances of meaning about the complexity of the TB approach. These varied according to the characteristics of the services in which they were inserted and of the people with TB. Strategies for dealing with complex cases were described: having interdisciplinary teams, acting together with other health effectors and dialoguing with civil society organizations under a territorial approach. Conclusion: The control of the TB problem in large urban conglomerates presents extensive challenges. From the perspective of health teams, complex situations are observed that require the development of certain strategies to address them. These allow the adaptation of interventions to provide an integrated response.Fil: Aranda, María Jimena. Municipalidad de General San Martin (buenos Aires).; ArgentinaFil: Barrios, Rocío Nahir. Universidad Nacional de Rosario; ArgentinaFil: Pereira, Andrés Martín. Gobierno de la Ciudad de Buenos Aires; ArgentinaFil: Mena, Maria Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; ArgentinaFil: Longordo, Marina Alexandra. Universidad de Buenos Aires; ArgentinaFil: Herrero, María Belén. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales. Sede Académica Argentina Buenos Aires. Área de Relaciones Internacionales; Argentin

Prevalence of submicroscopic malaria infection in immigrants living in Spain

BACKGROUND: The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area. METHODS: A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15. RESULTS: A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45-9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species. CONCLUSIONS: The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.This work was funded by projects PI14/01671, PI17/01791 and PI14CIII/00014, from the Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) and cofounded by the European Regional Development Fund, and approved by the Ethics Committee of our Institution. There was no funding from the PCR manufacturers; they did not play any role in data analysis or in the reporting of the results.S

Active monitoring of tuberculosis cases during the Covid-19 pandemic in a general hospital for acute patients in Buenos Aires City

A pesar de la existencia de un tratamiento efectivo, la persistencia de la tuberculosis (TB) en la Ciudad de Buenos Aires (CABA) señala los obstáculos presentes en la accesibilidad a los servicios de salud y la necesidad de visibilizar los determinantes sociales en la adherencia a los tratamientos antituberculosos. El contexto de la pandemia de covid-19 y del aislamiento social preventivo y obligatorio (ASPO) implicaron un fuerte desafío para reorganizar los servicios de salud y afecta de manera exacerbada a los grupos en situación de pobreza y vulnerabilidad social. Este artículo se propone señalar los principales resultados de la implementación de una modalidad de seguimiento activo de los casos de tuberculosis en un hospital general de agudos de CABA entre 2020 y 2021. Se utilizó un diseño de investigación en implementación con una metodología cuantitativa y cualitativa para reconocer los principales obstáculos en el seguimiento y la adherencia a los tratamientos antifímicos en el contexto de la pandemia de covid-19. Se identificaron los grupos sociales afectados por la TB con mayor vulnerabilidad social para el seguimiento: población en situación de calle, con consumo problemático de sustancias y población transfemenina. Se señala el armado de redes comunitarias con referentes de organizaciones de la sociedad civil como una estrategia efectiva para acompañar a esta población.Despite an effective treatment, the persistence of tuberculosis (TB) in the City of Buenos Aires (CABA, its acronym in Spanish) indicates the obstacles in accessibility to health services and the need to make the social determinants of adherence to the tuberculosis treatments visible. The covid-19 pandemic together with the preventive and compulsory social isolation (ASPO, its acronym in Spanish) mean a strong challenge for reorganizating health services and exacerbate the problems of poor and socially vulnerable groups. This article aims to show the main results of implementing an active follow-up modality of TB cases in a general hospital for acute patients in CABA in 2020-2021. The main obstacles in the follow-up and adherence to anti-fimic treatments in the context of the covid-19 pandemic were identified through a research design with quantitative and qualitative methodology. Social groups affected by TB and higher social vulnerability were identified for the follow-up: homeless, those with problematic substance use, and trans-female. Setting community networks with mentors from civil society organizations were an effective strategy for accompanying these populations.Fil: Pereyra, Andrés Martín. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Barrios, Rocio. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Aranda, Jimena. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Herrero, María Belén. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Longordo, Marina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Hering, Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Ben, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Koufios, Adriana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Marcuzz, Adriana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Camera, Eugenia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Catalano, Adriana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Paz, Enroque. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; Argentin

Efficacy of heat-inactivated Mycobacterium bovis vaccine delivered to European badgers (Meles meles) through edible bait

[EN] Badgers (Meles meles) are a major tuberculosis (TB) reservoir in Europe, with the potential to transmit infection to cattle. Here we assessed whether a recently described oral tuberculosis vaccine based on heat-inactivated Mycobacterium bovis (HIMB), delivered as edible baits, can protect badgers from infection. Eight badgers were given individually five baits, each one consisting of a ball of peanut butter, natural peanut and oat flakes including a dose of the vaccine containing 5 × 107 colony-forming units. In parallel, a control group of seven badgers did not receive the vaccine. One month and a half later a second dose of the vaccine was offered to the vaccinated group. Ninety-four days after the second dose, all badgers were challenged with M. bovis (103 colony-forming units per animal) delivered endobronchially to the right middle lung lobe. Clinical, immunological, pathological and bacteriological variables were measured throughout the whole study to assess the efficacy of the vaccine. Two vaccinated animals showed high bacterial load of M. bovis and worsening of pathological lesions of TB. Conversely, the other six vaccinated animals showed slight improvement in bacterial load and pathology with respect to the control group. These results suggest that delivering the TB vaccine via food bait can partially protect wild badger populations, although vaccination can lead to either protection or tolerization, likely depending on the animal's immune status and general condition at the time of vaccination. Further optimization of the vaccination trial/strategy is needed to reduce the rate of tolerization, such as altering vaccine dose, number of doses, type of bait, use of adjuvants or route of administration.S

Apps y economía II. Memoria final

Memoria ID-0182. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2015-2016

Renovación de las prácticas de Ecología: Aprendiendo Ecología Acuática

Depto. de Biodiversidad, Ecología y EvoluciónFac. de Ciencias GeológicasFac. de Ciencias BiológicasFALSEsubmitte

DPYD Exome, mRNA Expression and Uracil Levels in Early Severe Toxicity to Fluoropyrimidines: An Extreme Phenotype Approach

Dihydropyrimidine dehydrogenase deficiency is a major cause of severe fluoropyrimidine-induced toxicity and could lead to interruption of chemotherapy or life-threatening adverse reactions. This study aimed to characterize the DPYD exon sequence, mRNA expression and in vivo DPD activity by plasma uracil concentration. It was carried out in two groups of patients with extreme phenotypes (toxicity versus control) newly treated with a fluoropyrimidine, during the first three cycles of treatment. A novel nonsense gene variant (c.2197insA) was most likely responsible for fluoropyrimidine-induced toxicity in one patient, while neither DPYD mRNA expression nor plasma uracil concentration was globally associated with early toxicity. Our present work may help improve pharmacogenetic testing to avoid severe and undesirable adverse reactions to fluoropyrimidine treatment and it also supports the idea of looking beyond DPYD

Methodology applied in the study of the language development in children with early detection of neonatal hearing loss.

Introducción y objetivo: Dado que el potencial discapacitante que causa la deficiencia auditiva neonatal disminuye con una detección e intervención tempranas, hemos elaborado un proyecto de investigación, con el que nos proponemos conocer el grado de desarrollo del lenguaje de los niños y niñas que procedentes del cribado auditivo universal, han sido diagnosticados/as por nosotros de hipoacusia prelingual en estos últimos 15 años y analizar las variables determinantes y las que son modificables. El objeto de esta comunicación consistirá en presentar la metodología que vamos a utilizar. Método: Partimos de los datos almacenados en nuestro Servicio de ORL, que comprende a 282 niños con hipoacusia. Hemos tenido la oportunidad de crear un grupo de investigación en el que coincidimos especialistas de la audición infantil y del lenguaje, por lo que contamos con medios suficientes para el estudio. Resultados: Describimos los elementos que configuran este proyecto, en relación al equipo de trabajo y a su desarrollo. Tras aplicar unos criterios de exclusión/inclusión, hemos seleccionado a un grupo de 45 niños entre 3 y 15 años, definiendo sus características auditivas. Mediante pruebas específicas, adaptadas a la edad, estudiaremos los diferentes aspectos del lenguaje; y a través de una entrevista estructurada realizada a los padres, intentaremos determinar las variables que influyen en el proceso re-habilitador. Finalmente, los datos serán analizados estadísticamente. Discusión: La variabilidad y la escasa prevalencia de la hipoacusia infantil, dificultan la realización de estudios con población suficiente para obtener resultados estadísticamente significativos. Sin embargo, creemos que el grupo de niños seleccionado y la metodología utilizada nos permitirán conocer mejor las variables influyentes en el desarrollo del lenguaje. Conclusiones: El programa de cribado auditivo universal ha permitido una intervención más precoz, lo que debería mejorar los niveles de lenguaje de los niños detectados/as con hipoacusia. Aunque el desarrollo normalizado de la comunicación depende de otros factores difíciles de determinar, a través del protocolo presentado pretendemos equiparar estos resultados, validando el proceso de cribado/diagnóstico e intervención de nuestro medio.Introduction and objective: Given that the disabling potential causing neonatal hearing impairment decreases with early detection and intervention, we have drawn up a research project, with which we intend to know the degree of development of the language of children and girls than from the universal hearing screening, have been diagnosed for us of prelingual hearing loss in the last 15 years and analyze the determining variables and which are modifiable. The object of this communication will be to present the methodology that we use. Method: We assume the data stored on our ENT service, including 282 children with hearing loss. We have had the opportunity to create a research group in which we agree ENT and language specialists so we have resources sufficient for the study. Results: We describe the elements that make up this project in relation to the team and to its development. After applying inclusion/exclusion criteria, we have selected a group of 45 children between 3 and 15 years, defining their auditory characteristics. Through specific tests, adapted to the age, we will study the different aspects of the language; and through a structured interview parents, we try to determine the variables that influence the rehabilitator process. Finally, the data will be analyzed statistically. Discussion: The variability and the low prevalence of infant hearing loss, make it difficult studies with sufficient population to obtain statistically significant results. However, we believe that the group of children and the methodology selected will allow us to learn more about the influential in the development of the language variables. Conclusions: The hearing screening program allowed us to earlier intervention, which should improve the levels of language of children detected with hearing loss. Although the standard development of communication depends on other factors difficult to determine, through the presented protocol we equate these findings, validating the process of screening/diagnosis and intervention of our environment

El reto de la inclusión de los Objetivos de Desarrollo Sostenible en la formación inicial de profesores de secundaria: creación del MOOC curso cero sobre educación y ODS, inclusión en asignaturas y en trabajos fin de máster

Memoria ID-041. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2021-2022

Heterozygous and Homozygous Variants in SORL1 Gene in Alzheimer's Disease Patients: Clinical, Neuroimaging and Neuropathological Findings

In the last few years, the SORL1 gene has been strongly implicated in the development of Alzheimer’s disease (AD). We performed whole-exome sequencing on 37 patients with early-onset dementia or family history suggestive of autosomal dominant dementia. Data analysis was based on a custom panel that included 46 genes related to AD and dementia. SORL1 variants were present in a high proportion of patients with candidate variants (15%, 3/20). We expand the clinical manifestations associated with the SORL1 gene by reporting detailed clinical and neuroimaging findings of six unrelated patients with AD and SORL1 mutations. We also present for the first time a patient with the homozygous truncating variant c.364C>T (p.R122*) in SORL1, who also had severe cerebral amyloid angiopathy. Furthermore, we report neuropathological findings and immunochemistry assays from one patient with the splicing variant c.4519+5G>A in the SORL1 gene, in which AD was confirmed by neuropathological examination. Our results highlight the heterogeneity of clinical presentation and familial dementia background of SORL1-associated AD and suggest that SORL1 might be contributing to AD development as a risk factor gene rather than as a major autosomal dominant gene.This work was supported by the Instituto de Salud Carlos III (PI17/01067) and AGAUR from the Autonomous Catalan Government (2017SGR1134). Dr. Víctor Antonio Blanco-Palmero is supported by the Instituto de Salud Carlos III (ISCIII, Spanish Biomedical Research Institute) through a “Río Hortega” contract (CM18/0095). Dr. Sara Llamas-Velasco is supported by the Instituto de Salud Carlos III (ISCIII; Spanish Biomedical Research Institute) through a “Juan Rodés” contract (JR 18/00046).S