Un examen actualizado de la percepción de las barreras para la implementación de la farmacogenómica y la utilidad de los pares fármaco/gen en América Latina y el Caribe

La farmacogenómica (PGx) se considera un campo emergente en los países en desarrollo. La investigación sobre PGx en la región de América Latina y el Caribe (ALC) sigue siendo escasa, con información limitada en algunas poblaciones. Por lo tanto, las extrapolaciones son complicadas, especialmente en poblaciones mixtas. En este trabajo, revisamos y analizamos el conocimiento farmacogenómico entre la comunidad científica y clínica de ALC y examinamos las barreras para la aplicación clínica. Realizamos una búsqueda de publicaciones y ensayos clínicos en este campo en todo el mundo y evaluamos la contribución de ALC. A continuación, realizamos una encuesta regional estructurada que evaluó una lista de 14 barreras potenciales para la aplicación clínica de biomarcadores en función de su importancia. Además, se analizó una lista emparejada de 54 genes/fármacos para determinar una asociación entre los biomarcadores y la respuesta a la medicina genómica. Esta encuesta se comparó con una encuesta anterior realizada en 2014 para evaluar el progreso en la región. Los resultados de la búsqueda indicaron que los países de América Latina y el Caribe han contribuido con el 3,44% del total de publicaciones y el 2,45% de los ensayos clínicos relacionados con PGx en todo el mundo hasta el momento. Un total de 106 profesionales de 17 países respondieron a la encuesta. Se identificaron seis grandes grupos de obstáculos. A pesar de los continuos esfuerzos de la región en la última década, la principal barrera para la implementación de PGx en ALC sigue siendo la misma, la "necesidad de directrices, procesos y protocolos para la aplicación clínica de la farmacogenética/farmacogenómica". Las cuestiones de coste-eficacia se consideran factores críticos en la región. Los puntos relacionados con la reticencia de los clínicos son actualmente menos relevantes. Según los resultados de la encuesta, los pares gen/fármaco mejor clasificados (96%-99%) y percibidos como importantes fueron CYP2D6/tamoxifeno, CYP3A5/tacrolimus, CYP2D6/opioides, DPYD/fluoropirimidinas, TMPT/tiopurinas, CYP2D6/antidepresivos tricíclicos, CYP2C19/antidepresivos tricíclicos, NUDT15/tiopurinas, CYP2B6/efavirenz y CYP2C19/clopidogrel. En conclusión, aunque la contribución global de los países de ALC sigue siendo baja en el campo del PGx, se ha observado una mejora relevante en la región. La percepción de la utilidad de las pruebas PGx en la comunidad biomédica ha cambiado drásticamente, aumentando la concienciación entre los médicos, lo que sugiere un futuro prometedor en las aplicaciones clínicas de PGx en ALC.Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region’s continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the “need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics”. Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%–99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC

An Updated Examination of the Perception of Barriers for Pharmacogenomics Implementation and the Usefulness of Drug/Gene Pairs in Latin America and the Caribbean

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region’s continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the “need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics”. Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%–99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC

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

La renovación de la palabra en el bicentenario de la Argentina : los colores de la mirada lingüística

El libro reúne trabajos en los que se exponen resultados de investigaciones presentadas por investigadores de Argentina, Chile, Brasil, España, Italia y Alemania en el XII Congreso de la Sociedad Argentina de Lingüística (SAL), Bicentenario: la renovación de la palabra, realizado en Mendoza, Argentina, entre el 6 y el 9 de abril de 2010. Las temáticas abordadas en los 167 capítulos muestran las grandes líneas de investigación que se desarrollan fundamentalmente en nuestro país, pero también en los otros países mencionados arriba, y señalan además las áreas que recién se inician, con poca tradición en nuestro país y que deberían fomentarse. Los trabajos aquí publicados se enmarcan dentro de las siguientes disciplinas y/o campos de investigación: Fonología, Sintaxis, Semántica y Pragmática, Lingüística Cognitiva, Análisis del Discurso, Psicolingüística, Adquisición de la Lengua, Sociolingüística y Dialectología, Didáctica de la lengua, Lingüística Aplicada, Lingüística Computacional, Historia de la Lengua y la Lingüística, Lenguas Aborígenes, Filosofía del Lenguaje, Lexicología y Terminología

El Derecho Argentino frente a la pandemia y post-pandemia COVID-19. TOMO III

La Facultad de Derecho de la Universidad Nacional de Córdoba no podía permanecer indolente frente a la conmoción que, durante este año 2020, ha provocado en el mundo la pandemia de COVID-19. Como comunidad educativa advertíamos que la prioridad máxima era lograr la continuidad de la labor de nuestra Casa de Estudios, para garantizar a nuestros alumnos del grado y del posgrado, el ejercicio de su derecho a estudiar, continuando y en algunos casos iniciando sus estudios, a pesar de las condiciones adversas que se vivían. Con esa finalidad convocamos a los profesores titulares de todas las cátedras y eméritos y consultos que quisieran hacerlo, a sumarse con sus aportes a esta construcción colectiva, que aborda los temas que nos ocupan desde las diversas perspectivas de las distintas áreas del mundo jurídico. Y la desinteresada respuesta positiva no se hizo esperar. Prueba de ello es este libro cuyas dimensiones, tanto en lo cuantitativo como en lo cualitativo, superaron las expectativas iniciales. La jerarquía de los autores que generosamente han participado con sus contribuciones, en algunos casos en forma individual y en otros acompañados por sus equipos de colaboradores, permiten prever que esta obra ha de brindar elementos de juicio de gran utilidad para continuar construyendo el mundo jurídico, dentro de la pandemia y después de ella.ÍNDICE GENERAL. TOMO III. DERECHO DE LOS RECURSOS NATURALES Y AMBIENTAL. "El Derecho Ambiental frente a la pandemia y post pandemia COVID-19 algunas perspectivas" por Aldo Novak. "Sustentabilidad y extractivismo: análisis crítico en contexto de pandemia" por Darío Ávila, María Laura Foradori y Soledad Graupera. II. "Género y ambiente: su inclusión en la agenda pública a partir del COVID-19" por Graciela Tronca María Cecilia Tello Roldán, María Eugenia Villalba y Candela González. DERECHO DE LA NAVEGACIÓN, TRANSPORTE Y COMUNICACIONES. "Derecho Aduanero. Derecho del turismo" por Giselle Javurek. Profesores: M. Soledad Pesqueira Nozikovsky, Ernesto Frontera Villamil, Juan Marcelo Cinalli y Hugo Rivarola. Adscriptos: Nelly Baigorria, Diego Cevallos, Victoria Ferronato, Maricel Freijo, M. Victoria Giubergia, Paula González Boarini,Guadalupe Hidalgo, Ignacio Latini Marramá, Iván Luna, Noelia I Mana, Dante Ariel Nuñez, Lucía Olivier y Erika Saimandi. DERECHO PROCESAL. "La justicia y el proceso judicial frente a la pandemia y post pandemia COVID-19" por Rosa A. Avila Paz de Robledo. Profesores: Mario R. Lescano, Mariano G. Lescano, Mariela Roldán, Carolina Vallania, Roxana Garay, y Santiago Molina Sandoval. "La Justicia y las personas en condiciones de vulnerabilidad frente a la Pandemia y Post Pandemia COVID-19" por Rosa A. Avila Paz de Robledo Federico M. Arce, Víctor Luna Cáceres, Horacio L. Cabanillas, Miriam Mabel Marchetti, Daniela Moyano Escalera, Eric A. Opl. "Acceso a la justicia en el COVID-19. Caso fortuito y la reforma procesal" por Cristina González de la Vega. "Nuevas tecnologías en la justicia civil de Córdoba en tiempos de pandemia COVID-19" por Leonardo González Zamar. "El proceso judicial en la época de la pandemia COVID-19. El Ministerio Público Fiscal en la oralidad" por Silvia Elena Rodríguez y Ariel Ksen. "Garantías judiciales en el COVID-19 desde la perspectiva del Sistema Interamericano de Derechos Humanos y del sistema jurídico argentino" por Diego Robledo. "La protección de datos personales en la nueva normalidad: salud pública y vigilancia digital" por María Cecilia Tello Roldan. "La emergencia sanitaria COVID-19 y la tecnología en los procesos de familia en la provincia de Córdoba" por Mariela Denise Antun y Sonia Elizabeth Cabral. "Justicia y pandemia: medidas implementadas en la justicia federal y provincial en el marco del COVID-19" por Adriana De Cicco, Ramón Agustín Ferrer Guillamondegui,Natalia Luna Jabase y Mauricio Zambiazzo. "La pandemia c 19 y el proceso judicial en Córdoba. Algunas reflexiones y las audiencias en el proceso penal" por Emilio Albarenga y Rodolfo Gaspar Lingua Rostagno. TEORÍAS DEL CONFLICTO Y DE LA DECISIÓN. MÉTODOS DERESOLUCIÓN DE CONFLICTOS. "Pensando con Morin en tiempos de incertidumbre. La noción de sujeto y la organización de los conocimientos" por Elena Garcia Cima de Esteve y Noemi G. Tamashiro de Higa. "El derecho argentino frente a la pandemia: los aportes desde la teoría del conflicto y los rad" por Daniel Gay Barbosa. "Estragos vs. orden jurídico: consenso superador para la protección de los derechos" por María Cristina Di Pietro. "El aislamiento y la resolución de conflictos. Raúl Álvarez" por Sergio Cattaneo. "El rol de mediador. Del amor en los tiempos del coronavirus" por Carla Saad y Leonardo Colazo. DERECHO POLITICO. "Pandemia. Decretos de necesidad y urgencia y constitución" por Jorge Edmundo Barbará. "La reformulación estatal en un escenario de globalización y pandemia" por Carlos Juárez Centeno. ECONOMIA. "Resolución de la CIDH 1/2020 “pandemia y derechos humanos en las Américas”. Una aproximación integral al documento emitido por la Comisión Interamericana de Derechos Humanos de la OEA" por Daniel Gattás. EDUCACION Y PANDEMIA. "Educación y pandemia. Introducción" por Graciela Ríos. "La política y el derecho educacional argentinos en tiempos de pandemia" por Claudia Giacobbe y María Florencia Blanco Pighi. "“Educar” en pandemia el acceso a la educación digital vs la desigualdad en tiempos de pandemia" por Noelia Nieva, Rosa Carnero, Florencia Pereyra y Lucas Cajeao. "Digitalización e igualdad educativa. ¿un equilibrio inestable? Un análisis de los espacios virtuales, las TIC y su necesidad en la educación básica a partir de la experiencia de emergencia sanitaria y confinamiento social" por Matías Parmigiani y Paula Gastaldi. ETICA Y DERECHO. "La pandemia como remedio de la política" por Hugo Omar Seleme. SOCIOLOGIA JURIDICA. "Pandemia COVID-19. Biopolítica y estado de excepción" por Martha Díaz de Landa.Fil: Novak, Aldo. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Ávila, Darío. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Foradori, María Laura. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Graupera, Soledad. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Tronca, Graciela. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Tello Roldán, María Cecilia. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Villalba, María Eugenia. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: González, Candela. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Javurek, Giselle. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Pesqueira Nozikovsky, M. Soledad. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina.Fil: Frontera Villamil, Ernesto. Universidad Nacional de Córdoba. Facultad de Derecho; Argentina

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted