Facts and reflections on COVID-19 and anti-hypertensives drugs

Based on some publications that associate SARS-CoV-2 infection with the use of anti-hypertensivedrug groups such as angiotensin-converting-enzyme inhibitors (e.g. enalapril) or angiotensin IIreceptor blockers (e.g. losartan), many patients from South America, Central America or Spain,have stopped or intend to interrupt their treatments with these drugs. Hence, it may exist ominousconsequences due to this drop out. For this reason, it is necessary to quickly warn about thissituation and the risks associated with it.Fil: Marin, Gustavo Horacio. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Impact in the reduction of complications through a personalized follow-up strategy to ensure adherence to antihypertensive therapy

The lack in continuity of antihypertensive treatment is one of the major common causes of uncontrolled high blood pressure and increased of adverse effects and medical costs associated to this disease. The current study aimed to investigate the relationship between a personalized strategy that guarantees the adherence to antihypertensive treatment and complications related to hypertension. To do so, 586 patients hypertensive patients attending primary care institutions in La Plata Argentina, were randomly assigned either to an intervention group that had regular and periodically follow up contact to check treatment adherence or to control group. Both groups received free of charge antihypertensive medicines. The adherence was assessed with the adherence evaluation scale of Girerd. The presence of complications of hypertension disease (stroke, angina pectoris, myocardial infarct, transient ischemic attack, heart failure, kidney failure, retinopathy and death associated to this disease) were checked monthly. Among the 293 patients included in the intervention group study 98.63 % (289/293) were adherents while only 49.14% (144/293) of the control group had continuity in the therapy. Comparing complications events developed by patients belonging to Intervention vs Control group after 24 month of follow up were for overall events 19.79% vs 27.98% (p<0.001), for stoke 0.34/1.02%(pNS); angina pectoris 4.09/6.48% (p 0.004), 0.68/1.02 (pNS), TIA 0/0.34% (p NS), heart failure 4.77 /7.16% (p0.003), while hospitalization associate to primary hypertension disease was 16.04/30.3% (p<0.001)respectively. We can conclude that a personalized strategy to guarantee hypertension treatment adherence reduce the hospitalization and several complication associated to this disease.Fil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Errecalde, Jorge Oscar. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

The Role of Midwives in the First Level Of Health Care System

Since the beginning of human history the process of childbirth has been acknowledged as a life event involving bio-physiological as well as socio-cultured and psychological aspects. All cultures throughout history have had strategies to assist and accompany women during labor and birth, being the image of a midwife present in current and past societies. In Argentina, as in many countries of Latin America, the official discourses assign on midwifery a key role in primary health care. However, the absence of midwifes in the first level of health care leaves pregnancy, labor and postpartum controls under other professionals or under a hospital level care. In this paper we mention some successful experiences that were able to reduce maternal and child risk indicators only through the inclusion of midwives in the primary care health staff. The profile and attitude of midwife’s care during pregnancy, delivery and assistance of pregnant women during gestational period cannot be replaced by other professionals.Fil: Salsa Cortizo, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

Litigation for health technology accessibility: A tool for inequality? Reflections based on case study analysis

INTRODUCTION: The objective of this work is to analyze the characteristics of litigation for access to health’s goods and services in the Social Health Insurance (SHI) of Buenos Aires, Argentina. METHOD: Descriptive study with analytical stage, performed in SHI, analyzing litigation done by beneficiaries along 15-years period to obtain goods or service from health managers. Variables explored were: Reason for litigation, delay time in case resolution, final result of judicial sentence, judges, lawyers and intervening professionals, income level of beneficiaries who started the litigation. RESULT: 825 cases were analyzed during the study period according the method described. Demands increased 29.2 ±% per year. Medicines were the goods that most requested legal protection resources (32.5%). 51.9% of these litigations were due to medicines that have less than 24 months of registration by the National Regulatory Agency. The average delay for the final resolution of the procedure was 3.7 months. Judge's sentence was favorable to the beneficiaries in 97.4%. Although there are 27 judicial departments and many courts in each one; cases were concentrated in 47.4% only 2 very few courts. Litigation cases promoted by 112 out of the 15000 doctors that provides services to the SHI. In 73.7% of the cases, beneficiaries that litigated had a salary that exceed 4 times the minimum wage, and only 3.2% of them had low income. CONCLUSION: We show how legal appeals might be working as an inverse strategy to the one desired, transferring collective resources belonging to the entire population, towards an specific demand from the most economically wealthy sector of society. As long as access to health care litigation maintains its current individualistic pattern, it will hardly be able to develop its full potential to guarantee effective respect for the collective right to access to goods that beneficiary the whole community.Fil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Aguero, Daniel Alberto. Universidad Nacional Arturo Jauretche; ArgentinaFil: Marin, Gina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Pagnotta, Mariana. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Blanco, Luis. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

Impact of mental illnesses treatment during the period 1950-2020: Analysis of a single mental institution, Buenos Aires, Argentina

Introduction: Mental health treatment has varied in the last century; however, the impact of these new therapeutical options is little-known. Objectives: To evaluate the impact of treatments for mental health diseases along the last decades. Methodology: retrospective, descriptive case-report study. Medical records of patients admitted to a Mental Health Institution in Buenos Aires, Argentina were evaluated over 7 decades. Variables analyzed were: age, sex, diagnosis, time of hospital stay, number of re-hospitalizations, drugs available per decade, cost of drug, cost of hospitalizations. Results: Hospitalization average lenght of stay was 6.33 months, with 3.18 readmissions per patient. In the 21st century it was detected a reduction in the length of hospitalization (4.66 months) and an increase in the number of hospitalizations (4.3 hospitalizations/patient). The number of drugs prescribed was 5.14 per patient (1.6 in the 1950s and 7.22 in the last decade). During 1950s, the most prescribed drugs were lithium and chlorpromazine, in the ’60s haloperidol; in the ‘70s benzodiazepines, haloperidol, and amitriptyline; in the ‘80s and ‘90s fluoxetine, sertraline, and BZD; from the 2000s paroxetine, risperidone, and pregabalin were added to the earlier drugs; and in the current decade new antipsychotics (olanzapine, ziprasidone, quetiapine or lurasidone), antiepileptics (lamotrigine) were included. Although diagnoses were maintained over time (schizophrenia, psychosis, bipolar disorder, dementia, depression) in the last decade, 27.7% of the hospitalized patients had dual pathology (addiction+other mental illness). Cost of drugs prescribed increased >9 times, while the cost of hospitalization increased >4 times in the last decade compared to the second half of the 20th century. Conclusion: Although new drugs to treat severe mental disorders reduced side effects associate to treatment, its efficacy did not improve neither the duration of the hospital stay nor in the number of re-hospitalizations along the past 70 years; while cost of new drugs increased 9 times.Fil: Marin, Gustavo Horacio. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Giangreco, Lucia. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Valdez, Emilia. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Heig, Melina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Kersich, Blas. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, Gina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; Argentin

History of indigenous policies as trace of erythrocyte antigen Dia in the current population of the American continent relationship between indigenous policies and blood phenotypes

Objective: The study aim to establish a debate on the different policies implemented at indigenous population in the American continent and their relationship with the presence of DiegoA antigen (AgDia) in blood phenotype of inhabitants of Buenos Aires,Argentina. Methods: It is a descriptive study with qualitative/quantitative approach. A comprehensive search of medical/social databases, using MeSH words. Limits were applied to include studies published after 1950 written in Portuguese, English and Spanish. Results: Dia antigen in the population of several American countries is relatively high, hence, it should be considered in screening panels perform to blood donors. Noteworthy, the exception of this panorama is Buenos Aires State, where the prevalence of this antigen is low. This data was correlated with indigenous policies carried out by former governments. The results showed in population living in regions where Dia is high policy performed by the colonizers towards the indigenous peoples was domination+integration+miscegenation. In Buenos Aires, however, that policy was annihilation of the natives which could explain the low presence of the antigen in the current population. Conclusion: The presence of Ag-Dia in the population of Buenos Aires is low compared to other Latin-American regions. The presence of Ag-Dia in Buenos Aires population is low compared to other regions of Latin-America. The reason could be explained by the distinctive indigenous policy performed in this area. It might be possible then to predict the prevalence Dia in the current population, taking into account the history of indigenous policy in colonization of American continent.Fil: Azzaro, Sebastiana. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Marin, Gustavo Horacio. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Clapsos, Rosana. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; ArgentinaFil: Margineda, Silvia. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Cillero, Facundo. Provincia de Buenos Aires. Ministerio de Salud; Argentin

Erythropoietin treatment in chronic renal failure anaemia-biosimilar option in the rational use of medicine process in order to reduced public health economic burden

Biopharmaceuticals innovation molecules have changed the course of a large number of chronic diseases. Many of these molecules became Gold Standards in oncology, rheumatology and other illness. However, their cost makes these drugs unattainable for most patients, and often put the health systems’ budgets at risk. This study takes the anaemia due to Chronic Renal Failure disease (CRFD) as an example to a rational selection of treatment with erythropoietin (EPO) and compares the trade brand mark of this drug with biosimilars option. Prescriptions of EPO in 394 patients with CRFD were submitted to a protocol of rational selection based in efficacy/risk ratio demonstration. This protocol was able to reduce that initial number to 91 cases that could really benefited with EPO treatment. These patients were included in a cohort study that compared EPO trade mark with biosimilars option. The experience demonstrated equal clinical outcomes in both groups but a reduction to half the original cost when biosimilars were dispensed. Biosimilars demonstrated to be a cheap and safe option to increase medicine access for anaemia associated to CRFD.Fil: Marin, Gustavo Horacio. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Haag, Griselda Octavia. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; ArgentinaFil: Risso, Paula. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; ArgentinaFil: Errecalde, Jorge Oscar. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; Argentin

Assessment of the Graduates of the Medical Career on the Acquisition of Professional Competencies during their Training

Introduction: Competence-based medical education emerges as an effective pedagogical strategyfor solving problems and making decisions about the future professional. In our country, resolution1314/07 of the Ministry of Education defines basic professional skills to acquire during the career.Students' assessment of what they have learned is a source of information to evaluate the process,which is crossed by multiple individual and contextual factors that affect their training. The objectiveof this work is to analyze the assessment of graduates about their training process and the acquisitionof basic skills, and their relationship with certain individual and contextual characteristics.Methods: The assessment of 342 graduates of the medical career of the Faculty of Medical Sciences ofthe UNLP was analyzed. Information was collected on the following variables: Socio-demographiccharacteristics, academic trajectory, work history and assessment of the training received for each ofthe competencies defined by Ministry of Education.Results: Competencies valued as not fully acquired according to general practitioner profile. Thecomparative analysis showed a significant relationship between the assessment of competencies notfully acquired and students that work during their college career or according to the profession oftheir parents.Conclusion: results obtained will allow, to support the review of medical competencies demandedby the National Ministry of Education and to propose alternatives to improve the training processof those most vulnerable students.Fil: Ferrero, María Laura. Universidad Nacional de La Plata; ArgentinaFil: Ferrero, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Marin, Lupe. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Marin, Gustavo Horacio. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Escudero, Eduardo. Universidad Nacional de La Plata; ArgentinaFil: Etchegoyen, Graciela Susana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata; Argentin

Therapeutic profile of patients with diabetes treated at the first level of health care

Introduction: Diabetes mellitus type 2 (DM2) is a chronic metabolic disease frequently associated with late complications derived from progressive damage several tissues. When patients with DM2 do not respond adequately to non-pharmacological measures, anti-diabetic agents should be indicated to avoid the long-term risk of macro and microvascular complications. Objective: The aim of this study is to evaluate the therapeutic profile for DM2 in the first level of care in the health system in two different countries (Argentina and Paraguay). Methods: This study was an observational descriptive cross-section study. Variables considered were age, sex, date of disease debut, clinical signs of diabetes complications, blood pressure, abdominal circumference, anti-diabetic and anti-hypertensive drugs, and laboratory data. Results: Regarding medication, 30.6% of the patients were treated with biguanides (metformin) and 23.5% with oral hypoglycemic agents; 21.7% with a combination of both anti-diabetic groups; and 3.5% with other therapeutically options (glitazones, meglitinides, SGLT2 inhibitors, and GLP-1 agonist). All the cases of new drug indications were register in Argentina while in Paraguay; all drugs prescribed were considered essential medicines. Conclusion: Diabetes is a frequent disease that causes severe disabilities and death in the affected population. Although it exists several drugs for DM2 treatment, only a few of them follow the rational use of medicines guidelines, while other drugs might be unsafe and certainly more expensive than essential options. Since first level health-care therapeutic strategy plays a major role in avoiding complications from diabetes, countries with low or middle income such as Paraguay or Argentina should do efforts to provide to all patients a rational treatment. This work shows that not in all scenarios, this pattern is true.Fil: Maidana, Gladys Mabel. Universidad Nacional de Asunción; ParaguayFil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Exactas; ArgentinaFil: Samaniego, Lourdes. Universidad Nacional de Asunción; ParaguayFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Exactas; ArgentinaFil: Montiel, Dalva Fariña. Universidad Nacional de Asunción; ParaguayFil: Marin, Gina. Universidad Nacional de La Plata. Facultad de Ciencias Exactas; ArgentinaFil: Vera, Zully. Universidad Nacional de Asunción; ParaguayFil: Lugo Rodríguez, Gladys B.. Universidad Nacional de Asunción; Paragua

Evaluation of medication errors detected in private health sector prescriptions in Asuncion, Paraguay

The aim of the present research, performed in theNational University of Asuncion, is to determine the prevalence ofMedication Errors in prescription orders at the Private Health SectorPharmacy in Paraguay. Methods: This is a retrospectiveobservational study, whose main variable was the error inprescriptions, and its secondary variables were the number ofpatients reached by the errors and the type of error detected. Asimple random sampling technique was used to obtain 670 casesamong the universe of prescriptions made during the study period.Prescription errors were grouped according to the type of errorsfound. Results: 56.2% of the prescriptions received at the Pharmacysector have between 1 to 5 errors, and only in 43.8% of the cases, theprescriptions were complete. The most prevalent error was theomission of the patient's name, representing 51.58% of the totalerrors. The second most frequent type of error was the omission ofthe date of the prescription (20.18%), followed by errors in thepharmaceutical form (either by omission or by error) with 8.42%.Other types of errors represent percentages less than 8%. Theprevalence of prescription of medications by their generic namereached only 0.14 of the total prescriptions evaluated. Conclusion:In-depth training of prescribers of the Private Health Sector inParaguay is necessary. Encouraging the development of technicalskills in conjunction with active pharmaceutical care could improvethe quality of the prescription and reduce the amount of medicalerrors in the Paraguayan private health sector.Fil: Rotela de Grau, Virginia. Universidad Nacional de Asunción; ParaguayFil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Departamento de Articulación de Ciencias Básicas y Clínicas; ArgentinaFil: Morinigo, Macarena. Universidad Nacional de Asunción; ParaguayFil: Samaniego, Lourdes. Universidad Nacional de Asunción; ParaguayFil: Marin, Lupe. Universidad Nacional de La Plata; ArgentinaFil: Maidana, Gladys. Universidad Nacional de Asunción; ParaguayFil: Lugo, Gladys Beatriz. Universidad Nacional de Asunción; Paragua