Libres de humo: efectividad de un programa de cesación tabáquica en un Centro de Salud Comunitario de la Ciudad Autónoma de Buenos Aires

Introducción. El consumo de tabaco representa un importante desafío para la salud pública debido a su alta incidencia y mortalidad, y es el principal factor de riesgo modificable para desarrollar enfermedades crónicas no transmisibles. La Residencia de Medicina General y Familiar del Hospital General de Agudos Dr. Teodoro Álvarez desarrolló un programa de cesación tabáquica en el Centro de Salud y Acción Comunitaria N°34, que forma parte desde 2012 del Programa de Prevención y Control del Tabaquismo del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, Argentina. Objetivo. Documentar los resultados de la eficacia de este programa y explorar las variables relacionadas con la probabilidad de éxito y recaída. Materiales y métodos. Estudio cuantitativo, de corte transversal analítico, con datos obtenidos de historias clínicas electrónicas entre 2017 y 2020. Fueron incluidos los pacientes que consultaron al menos en dos ocasiones al programa de cesación tabáquica y establecieron un día D al menos 30 días antes del abandono del consumo de tabaco. La eficacia terapéutica fue definida como haber permanecido al menos seis meses sin fumar, y la recaída, como el reinicio de consumo del tabaco luego de haber logrado 24 horas de abstinencia con fecha posterior al día D. Resultados. De 59 pacientes, 24 (40,7%) lograron la eficacia terapéutica, de los cuales 5 (20,8 %) presentaron recaídas. De los 35 pacientes que no lograron alcanzar la etapa de mantenimiento, 30 (85,7%) recayeron durante las primeras ocho semanas. El sexo masculino y el consumo de tabaco superior a 20 paquetes-año mostraron una mayor correlación con las recaídas. Conclusiones. El programa presentó una eficacia terapéutica del 40,7% en el periodo evaluado. Se encontraron asociaciones entre una mayor eficacia terapéutica y ciertas características de los pacientes, pero se requieren más estudios para confirmar esta hipótesis

Robustness and autonomy in biological systems: how regulatory mechanisms enable functional integration, complexity and minimal cognition through the action of second-order control constraints

Living systems employ several mechanisms and behaviors to achieve robustness and maintain themselves under changing internal and external conditions. Regulation stands out from them as a specific form of higher-order control, exerted over the basic regime responsible for the production and maintenance of the organism, and provides the system with the capacity to act on its own constitutive dynamics. It consists in the capability to selectively shift between different available regimes of self-production and self-maintenance in response to specific signals and perturbations, due to the action of a dedicated subsystem which is operationally distinct from the regulated ones. The role of regulation, however, is not exhausted by its contribution to maintain a living system’s viability. While enhancing robustness, regulatory mechanisms play a fundamental role in the realization of an autonomous biological organization. Specifically, they are at the basis of the remarkable integration of biological systems, insofar as they coordinate and modulate the activity of distinct functional subsystems. Moreover, by implementing complex and hierarchically organized control architectures, they allow for an increase in structural and organizational complexity while minimizing fragility. Finally, they endow living systems, from their most basic unicellular instances, with the capability to control their own internal dynamics to adaptively respond to specific features of their interaction with the environment, thus providing the basis for the emergence of minimal forms of cognition

Systems and organizations: Theoretical tools, conceptual distinctions and epistemological implications.

The aim of this paper is to present some system-theoretical notions ─ such as constraint, closure, integration, coordination, etc. ─ which have recently raised a renovated interest and have undergone a deep development, especially in those branches of philosophy of biology characterized by a systemic approach. The im- plications of these notions for the analysis and characterization of self-maintaining organizations will be discussed with the aid of examples taken from models of minimal living systems, and some conceptual distinctions will be provided. In the last part of the paper the epistemic implications of these ideas will be presented

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

Robustness and Autonomy in Biological Systems: How Regulatory Mechanisms Enable Functional Integration, Complexity and Minimal Cognition Through the Action of Second-Order Control Constraints

International audienceLiving systems employ several mechanisms and behaviors to achieve robustness and maintain themselves under changing internal and external conditions. Regulation stands out from them as a specific form of higher-order control, exerted over the basic regime responsible for the production and maintenance of the organism, and provides the system with the capacity to act on its own constitutive dynamics. It consists in the capability to selectively shift between different available regimes of self-production and self-maintenance in response to specific signals and perturbations, due to the action of a dedicated subsystem which is operationally distinct from the regulated ones. The role of regulation, however, is not exhausted by its contribution to maintain a living system's viability. While enhancing robustness, regulatory mechanisms play a fundamental role in the realization of an autonomous biological organization. Specifically, they are at the basis of the remarkable integration of biological systems, insofar as they coordinate and modulate the activity of distinct functional subsystems. Moreover, by implementing complex and hierarchically organized control architectures, they allow for an increase in structural and organizational complexity while minimizing fragility. Finally, they endow living systems, from their most basic unicellular instances, with the capability to control their own internal dynamics to adaptively respond to specific features of their interaction with the environment, thus providing the basis for the emergence of minimal forms of cognition