Synthesis of 5-substituted 2-pyrrolidinones by coupling of organozinc reagents with cyclic N-acyliminium ions

En el presente trabajo se describe un procedimiento simple y fácil para la preparación de pirrolidinonas 5-sustituidas a partir de un acoplamiento entre iones N-aciliminio y reactivos organometálicos derivados de zincA coupling reaction between cyclic N-acyliminium ions with organozinc reagents is described. The cyclic N-acyliminium ions, generated in situ from N-substituted-5-hydroxy-2-pyrrolidinones by treatment with BF3-etherate or titanium tetrachloride, were trapped by the organozinc reagent, formed by the alkylbromide in the presence of zinc in the same reaction media. The N-substituted 5-allyl-2-pyrrolidinones generated using this method, serves as versatile intermediates for the synthesis of azabicyclic systems with indolizidine and pyrroloazepinolizidine cores

Comparación de la efectividad de la administración convencional de pilocarpina con otras formas, en el tratamiento de la xerostomía en pacientes adultos con Síndrome de Sjögren. Revisión sistemática.

131 p.INTRODUCCIÓN: La pilocarpina es uno de los sialogogos sistémicos más utilizados para el tratamiento de la xerostomía en pacientes con Síndrome de Sjögren. Actualmente no existe consenso sobre cuál es la forma de administración de pilocarpina más efectiva. OBJETIVO: Comparar la efectividad de la pilocarpina en sus diferentes formas de administración, en el tratamiento de pacientes adultos con Síndrome de Sjögren. MATERIALES Y MÉTODOS: Se realizó una revisión sistemática de la literatura en las bases de datos Web of Science, PubMed, The Cochrane Library y Scopus desde enero de 1991 hasta diciembre de 2017 utilizando la declaración PRISMA para su elaboración. Solo se incluyeron artículos de investigación en inglés y que fuesen realizados en humanos. Se analizaron las variaciones de flujo salival, la variación de síntomas de la xerostomía y los efectos secundarios en los estudios incluidos. Se realizó una evaluación de calidad metodológica y sesgo utilizando las herramientas del programa CASPe. RESULTADOS: Se incluyeron trece ensayos clínicos en la síntesis cualitativa de la evidencia. El análisis de flujo salival mostró diferencias en los protocolos de recolección de saliva, los momentos de medición de flujo salival y unidades de medida utilizadas. Se encontró una variedad de métodos de evaluación de síntomas de la xerostomía en los estudios incluidos. La evaluación de calidad mediante herramientas CASPe categorizó ocho estudios con calidad metodológica muy baja, uno con calidad moderada y cuatro con calidad alta. CONCLUSIONES: Al comparar los efectos secundarios de las diferentes formas de administración de pilocarpina, se evidenció que dosis mayores a la convencional presentaron una mayor variedad y frecuencia de efectos secundarios. PALABRAS CLAVE: Revisión Sistemática, Síndrome de Sjögren, Xerostomía, Tratamiento, Pilocarpina

Prevalence and trends of markers of hepatitis B virus, hepatitis C virus and human Immunodeficiency virus in Argentine blood donors

BACKGROUND: Transfusion-transmitted infections are a major problem associated with blood transfusion. The aim of this study was to determine prevalence and trends of HBV, HCV and HIV in blood donors in Argentina. METHODS: A retrospective study was carried out in blood donors of 27 transfusion centers covering the whole country over a period of eight years (2004-2011). Serologic screening assays for HBsAg, anti-HBc, anti-HCV, and anti-HIV were performed in all centers and nucleic acid amplification testing (NAT) was performed in 2 out of the 27 centers. RESULTS: The 2,595,852 samples tested nationwide from 2004 to 2011 showed that the prevalence of HBsAg decreased from 0.336% to 0.198% (p < 0.0001), that of anti-HBc from 2.391% to 2.007% (p < 0.0001), that of anti-HCV from 0.721% to 0.460%, (p < 0.0001) and that of anti-HIV from 0.208% to 0.200 (p = 0.075). The prevalence of HBV, HCV and HIV was unevenly distributed among the different regions of the country. Two out of 74,838 screening- negative samples were positive in NAT assays (1 HIV-RNA and 1 HCV-RNA); moreover, HBV-DNA, HCV-RNA and HIV-RNA were detected in 60.29, 24.54 and 66.67% of screening-positive samples of the corresponding assays. As regards donors age, positive HBV-DNA and HCV-RNA donors were significantly older than healthy donors (46.6, 50.5 and 39.5 y respectively, p < 0.001). CONCLUSIONS: Argentina has a low prevalence of HBsAg, anti-HCV and anti-HIV in blood donors, with a decreasing trend for HBsAg, anti-HBc and anti-HCV but not for anti-HIV over the last 8 years. The uneven distribution of transfusion-transmitted infections prevalence among the different regions of the country highlights the need to implement regional awareness campaigns and prevention. The discrepancy between samples testing positive for screening assays and negative for NAT assays highlights the problem of blood donors who test repeatedly reactive in screening assays but are not confirmed as positive upon further testing. The uneven distribution of age between healthy donors and NAT-positive donors could be related to changes in risks of these pathogens in the general population and might be attributed to a longer exposure to transmission risk factors in elderly people.Fil: Flichman, Diego Martin. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Blejer, Jorgelina L.. Fundación Hemocentro; ArgentinaFil: Livellara, Beatriz I.. Hospital Italiano; ArgentinaFil: Ré, Viviana Elizabeth. Universidad Nacional de Cordoba. Facultad de Medicina. Instituto de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bartoli, Sonia. Centro regional de Hemoterapia Jujuy; ArgentinaFil: Bustos, Juan A.. Banco de sangre San Jorge; ArgentinaFil: Ansola, Claudia P.. Provincia de Mendoza. Servicio de Hemoterapia; ArgentinaFil: Hidalgo, Susana. Hospital Dr. Enrique Vera Barros; ArgentinaFil: Cerda, Martín E.. Hospital Dr. Lucio Molas; ArgentinaFil: Levin, Alicia E.. Provincia de Mendoza. Servicio de Hemoterapia; ArgentinaFil: Huenul, Adriana. Hospital Artémides Zatti; ArgentinaFil: Riboldi, Victoria. Hospital Regional Río Gallegos; ArgentinaFil: Treviño, Elena M. C.. Universidad Nacional de Córdoba; ArgentinaFil: Salamone, Horacio J.. Fundación Favaloro; ArgentinaFil: Nuñez, Felix A.. Hospital Italiano; ArgentinaFil: Fernández, Robert J.. Fundación Hemocentro; ArgentinaFil: Reybaud, Juan F.. Fundación Favaloro; ArgentinaFil: Campos, Rodolfo Hector. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Virología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Voter information campaigns and political accountability: cumulative findings from a preregistered meta-analysis of coordinated trials

Voters may be unable to hold politicians to account if they lack basic information about their representatives’ performance. Civil society groups and international donors therefore advocate using voter information campaigns to improve democratic accountability. Yet, are these campaigns effective? Limited replication, measurement heterogeneity, and publication biases may undermine the reliability of published research. We implemented a new approach to cumulative learning, coordinating the design of seven randomized controlled trials to be fielded in six countries by independent research teams. Uncommon for multisite trials in the social sciences, we jointly preregistered a meta-analysis of results in advance of seeing the data. We find no evidence overall that typical, nonpartisan voter information campaigns shape voter behavior, although exploratory and subgroup analyses suggest conditions under which informational campaigns could be more effective. Such null estimated effects are too seldom published, yet they can be critical for scientific progress and cumulative, policy-relevant learning

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Intervención en un Hospital Geriátrico

This paper show a group intervention done by the Staff in a geriatric state hospital. The report includes the contract and the setting, the development of the group experience done through two groups that operate one after the other, and the diagnostical conlusions as well as the propositions presented to the authorities. Also, there is a discussion around some of the problems involved in this kind of intervention. The technique used was an adaptation of the Balint group, according to the kind of work to be done. In the same way, other theorical references are Pichón-Riviere's operative group frame, as well as the french institutional analysis. Some considerations are detailed.El presente trabajo da cuenta de una intervención grupal que el equipo de especialistas realizó en un hospital geriátrico estatal. Se detalla el contrato y el encuadre de trabajo, el desarrollo de la experiencia grupal realizada por medio de dos grupos de trabajo sucesivos, así como las conclusiones diagnósticas y las propuestas formuladas. Se discuten algunos de los problemas de una intervención de esta naturaleza. La técnica utilizada se ubica en el modelo del grupo Balint, el que fue adaptado a las circunstancias del trabajo. De igual modo, figuran en el marco referencial del equipo de especialistas el grupo operativo de Pichón-Riviere, así como el análisis institucional francés. Se detallan algunas reflexiones

Intervención en un Hospital Geriátrico

This paper show a group intervention done by the Staff in a geriatric state hospital. The report includes the contract and the setting, the development of the group experience done through two groups that operate one after the other, and the diagnostical conlusions as well as the propositions presented to the authorities. Also, there is a discussion around some of the problems involved in this kind of intervention. The technique used was an adaptation of the Balint group, according to the kind of work to be done. In the same way, other theorical references are Pichón-Riviere's operative group frame, as well as the french institutional analysis. Some considerations are detailed.El presente trabajo da cuenta de una intervención grupal que el equipo de especialistas realizó en un hospital geriátrico estatal. Se detalla el contrato y el encuadre de trabajo, el desarrollo de la experiencia grupal realizada por medio de dos grupos de trabajo sucesivos, así como las conclusiones diagnósticas y las propuestas formuladas. Se discuten algunos de los problemas de una intervención de esta naturaleza. La técnica utilizada se ubica en el modelo del grupo Balint, el que fue adaptado a las circunstancias del trabajo. De igual modo, figuran en el marco referencial del equipo de especialistas el grupo operativo de Pichón-Riviere, así como el análisis institucional francés. Se detallan algunas reflexiones