Ciudad Digital/Ciudad Inteligente o la utopía de la modernidad

Mucho se ha discutido sobre Ciudades Inteligentes y pocas veces hemos estado tan cerca del tema como este inolvidable año 2020; El covid nos puso a prueba a todos. Hemos discutido sobre la energía y los edificios de energía casi cero , pero nunca hemos diseñado redes para una conectividad casi sin cortes y términos como on-line on-time pasaron a ser sorpresas que considerábamos ampliamente evaluadas y con soluciones siempre al alcance de la mano. Nada mas lejos de la realidad, conectividad deficiente, geografía dispersa, concentración de ciudadanos en conglomerados para nada preparados.Centro de Ingenieros de la provincia de Buenos Aire

The Risk of Contracting COVID-19 Is Not Increased in Patients With Celiac Disease

The World Health Organization declared coronavirus disease-2019 (COVID-19) a global pandemic in March 2020. Since then, there are more than 34 million cases of COVID-19 leading to more than 1 million deaths worldwide. Numerous studies suggest that celiac disease (CeD), a chronic immune-mediated gastrointestinal condition triggered by gluten, is associated with an increased risk of respiratory infections.1-3 However, how it relates to the risk of COVID-19 is unknown. To address this gap, we conducted a cross-sectional study to evaluate whether patients with self-reported CeD are at an increased risk of contracting COVID-19

Evaluación del grado de adherencia a la dieta libre de gluten por cuatro semanas, basada en la determinación de la excreción de péptidos inmunogénicos de gluten en materia fecal y orina. Estudio exploratorio, prospectivo y observacional

Los pacientes celíacos en dieta libre de gluten (DLG) están frecuentemente expuestos a la ingesta voluntaria o involuntaria. Sin embargo, se desconoce la frecuencia en que se producen transgresiones en la vida real de los pacientes celíacos tratados. Recientes desarrollos permiten la determinación de la presencia de péptidos inmunogénicos de gluten (GIP) en materia fecal y orina, y estos constituyen herramientas útiles para evaluar la excreción de péptidos, un fenómeno específico indicativo de transgresiones a la DLG.Exploramos los patrones de excreción de GIP en materia fecal y orina por 4 semanas en una serie de pacientes celíacos tratados con DLGEstudio descriptivo y prospectivo en pacientes en DLG por más de dos años. Al ingreso, los pacientes completaron un índice de síntomas celíacos (CSI) para determinar su estado clínico. Todos los pacientes recolectaron muestras de materia fecal y orina por 4 semanas, de acuerdo con el siguiente protocolo: una última deposición fecal de los viernes (indicativo de consumo de gluten durante días de semana) y muestras de orina el domingo a la mañana y a la noche (recolección representativa de consumo en fines de semana). Se adoptó este esquema considerando que representa una cobertura completa de posibles transgresiones en la semana. El esquema se repitió 4 semanas consecutivas. La detección de GIP se efectuó por la prueba de ELISA (iVYLISA GIPS®, Biomedal S. L. Spain), y la de orina por pruebas rápidas (GlutenDetect®; Biomedal S. L. Spain). A la tasa de excreción de GIP se la comparó con los niveles basales de anticuerpos DGP IgA y tTG IgA. Enrolamos 57 pacientes, de los que se excluyeron 4 por transgresiones voluntarias. Evaluamos 53 pacientes en DLG por un tiempo mediano de 8 años (RIQ 5 a 12). De ellos, 47 pacientes (88.7 %) excretaron GIP al menos una vez en 4 semanas. La excreción de GIP en fines de semana (muestras deorina) fue positiva en 37/53 pacientes (69.8 %), en tanto que en heces (días de semana) se detectó en 33/53 (62.3 %) (pNS). La mediana transgresiones para la población general fue de 3 veces/4 semanas (RIQ: 1-5), 2 veces/4 semanas (RIQ 1-4) para pacientes asintomáticos, y 3 veces/semana (RIQ2-4) para sintomáticos. La frecuencia de excreción de GIP en heces se incrementó significativamente con el progreso del estudio (1ª vs. 4ª semanas; p< 0.05). Se observó una correlación significativa entre la frecuencia de transgresiones en 4 semanas y la concentración de anticuerpos DGP IgA (rho0.49; p<0.0001). El estudio demostró, por primera vez en la literatura internacional, que existe una muy alta frecuencia de exposición al gluten en pacientes celíacos tratados con dieta libre de gluten por largo plazo,a pesar de que ellos consideraban que cumplían estrictamente la exclusión de gluten. El fenómeno ocurre independientemente de la presencia de síntomas. El 90 % de los pacientes realizan al menos una transgresión por semana en el período de cuatro semanas, y el promedio es de 3 semanas por mes.La frecuencia de indiscreciones alimentarias es mayor durante los fines de semana que durante los días de la semana.Además, nuestra investigación demostró que las herramientas convencionales empleadas para evaluar la adherencia a la dieta libre de gluten tienen una performance pobre cuando se las compara con la absolutamente específica determinación de la excreción fecal de GIP (método marcador específicoy sensible de la exposición al gluten). Nuestro estudio nos permite sugerir que la excreción de GIP en heces determinada dos veces a la semana por cuatro semanas es una estrategia apropiada para explorar las indiscreciones dietarías y mejorar la adherencia a la dieta libre de gluten

Upper gastrointestinal endoscopic findings in celiac disease at diagnosis: A multicenter international retrospective study

BACKGROUND Gastroduodenal endoscopy and biopsy following positive specific serology is considered the gold standard to diagnose celiac disease (CeD) in adults. Whether upper endoscopy helps detect comorbid conditions is unknown. AIMTo investigate the prevalence of non-celiac endoscopic findings in patients in whom endoscopy was performed to confirm CeD diagnosis. METHODS This is an observational, descriptive, multicenter, retrospective study that reports endoscopic findings obtained in adult patients enrolled in local registries from four tertiary centers. We collected data reported on first endoscopy, indicated for investigation of CeD. Diagnosis of CeD was performed by histology (&amp; GE; Marsh 2 type mucosal damage) and specific serology. Two European and one North American center included biopsy-confirmed CeD following positive serology. A fourth center (South America) included symptomatic patients undergoing endoscopy, irrespective of CeD serology. The latter cohort included a non-CeD control group. RESULTS A total of 1328 patients (80% female; 35 years median age) were enrolled, of whom 95.6% had positive specific serology. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (prevalence: 10.1%). Erosive reflux esophagitis (6.4%), gastric erosions (2.0%), and suspicion of esophageal metaplasia (1.2%) were the most common findings. Biopsy-confirmed Barrett's esophagus was infrequent (0.2%). No endoscopic cancer was detected. Older patients (&amp; GE; 51 years of age) had a higher prevalence of endoscopic findings than those &amp; LE; 50 (P &lt; 0.01). Within the South American cohort, CeD was associated with a lower rate (8.2%) of comorbid endoscopic findings compared with controls (29.1%; P &lt; 0.001). In the adjusted multivariate analysis of this cohort, having CeD was associated with a 72% reduction in the risk of any endoscopic abnormality (P &lt; 0.0001), and having alarm symptoms was associated with a 37% reduction in the risk of finding at least one endoscopic lesion (P &lt; 0.02). CONCLUSION In this large multicenter study, young adults with positive CeD serology had few comorbid endoscopic findings. Although patients over 51 years had a high prevalence of non-CeD gastroduodenal mucosal damage, no malignancy or premalignant lesions were found

Upper gastrointestinal endoscopic findings in celiac disease at diagnosis: A multicenter international retrospective study

Background: Gastroduodenal endoscopy and biopsy following positive specific serology is considered the gold standard to diagnose celiac disease (CeD) in adults. Whether upper endoscopy helps detect comorbid conditions is unknown. Aim: To investigate the prevalence of non-celiac endoscopic findings in patients in whom endoscopy was performed to confirm CeD diagnosis. Methods: This is an observational, descriptive, multicenter, retrospective study that reports endoscopic findings obtained in adult patients enrolled in local registries from four tertiary centers. We collected data reported on first endoscopy, indicated for investigation of CeD. Diagnosis of CeD was performed by histology (≥ Marsh 2 type mucosal damage) and specific serology. Two European and one North American center included biopsy-confirmed CeD following positive serology. A fourth center (South America) included symptomatic patients undergoing endoscopy, irrespective of CeD serology. The latter cohort included a non-CeD control group. Results: A total of 1328 patients (80% female; 35 years median age) were enrolled, of whom 95.6% had positive specific serology. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (prevalence: 10.1%). Erosive reflux esophagitis (6.4%), gastric erosions (2.0%), and suspicion of esophageal metaplasia (1.2%) were the most common findings. Biopsy-confirmed Barrett's esophagus was infrequent (0.2%). No endoscopic cancer was detected. Older patients (≥ 51 years of age) had a higher prevalence of endoscopic findings than those ≤ 50 (P < 0.01). Within the South American cohort, CeD was associated with a lower rate (8.2%) of comorbid endoscopic findings compared with controls (29.1%; P < 0.001). In the adjusted multivariate analysis of this cohort, having CeD was associated with a 72% reduction in the risk of any endoscopic abnormality (P < 0.0001), and having alarm symptoms was associated with a 37% reduction in the risk of finding at least one endoscopic lesion (P < 0.02). Conclusion: In this large multicenter study, young adults with positive CeD serology had few comorbid endoscopic findings. Although patients over 51 years had a high prevalence of non-CeD gastroduodenal mucosal damage, no malignancy or premalignant lesions were found

Natural tannin extracts supplementation for COVID-19 patients (TanCOVID): a structured summary of a study protocol for a randomized controlled trial.

This research aims to study the efficacy of tannins co-supplementation on disease duration, severity and clinical symptoms, microbiota composition and inflammatory mediators in SARS-CoV2 patients. This is a prospective, double-blind, randomized, placebo-controlled, parallel-group trial to evaluate the efficacy of the administration of the dietary supplement ARBOX, a molecular blend of quebracho and chestnut tannins extract and Vit B12, in patients affected by COVID-19. 18 years of age or older, admitted to Hospital de Clinicas Jose de San Martin, Buenos Aires University (Argentina), meeting the definition of "COVID-19 confirmed case" ( https://www.argentina.gob.ar/salud/coronavirus-COVID-19/definicion-de-caso ). Inclusion Criteria Participants are eligible to be included in the study if the following criteria apply: 1. Any gender 2. ≥18 years old 3. Informed consent for participation in the study 4. Virological diagnosis of SARS-CoV-2 infection (real-time PCR) Exclusion Criteria Participants are excluded from the study if any of the following criteria apply: 1. Pregnant and lactating patients 2. Patients who cannot take oral therapy (with severe cognitive decline, assisted ventilation, or impaired consciousness) 3. Hypersensitivity to polyphenols 4. Patients already in ICU or requiring mechanical ventilation 5. Patients already enrolled in other clinical trials 6. Decline of consent INTERVENTION AND COMPARATOR: Experimental: TREATED ARM Participants will receive a supply of 28 -- 390 mg ARBOX capsules for 14 days. Patients will be supplemented with 2 capsules of ARBOX per day. Placebo Comparator: CONTROL ARM Participants will receive placebo supply for 14 days. The placebo will be administered with the identical dose as described for the test product. All trial participants will receive standard therapy, which includes: Antipyretics or Lopinavir / Ritonavir, Azithromycin and Hydroxychloroquine, as appropriate (treatment currently recommended by the department of Infectious Diseases of the Hospital de Clínicas that could undergo to modifications). In addition, if necessary: supplemental O2, non-invasive ventilation, antibiotic therapy. Primary Outcome Measures: Time to hospital discharge, defined as the time from first dose of ARBOX to hospital discharge [ Time Frame: Throughout the Study (Day 0 to Day 28) ] Secondary Outcome Measures: 28-day all-cause mortality [ Time Frame: Throughout the Study (Day 0 to Day 28) ]-proportion Invasive ventilation on day 28 [ Time Frame: Throughout the Study (Day 0 to Day 28) ]-proportion Level of inflammation parameters and cytokines [ Time Frame: day 1-14 ] -mean difference Difference in fecal intestinal microbiota composition and intestinal permeability [ Time Frame: day 1-14 ] Negativization of COVID-PCR at day 14 [ Time Frame: day 14 ]-proportion RANDOMIZATION: Potential study participants were screened for eligibility 24 hours prior to study randomization. Patients were randomly assigned via computer-generated random numbering (1:1) to receive standard treatment coupled with tannin or standard treatment plus placebo (control group). Study personnel and participants are blinded to the treatment allocation, as both ARBOX and placebo were packed in identical containers. Thus, all the used capsules had identical appearance. Considering an alpha error of 5%, a power of 80% a sample size of 70 patients per branch was estimated. 140 patients in total. The protocol version is number V2, dated May 23, 2020. The first patient, first visit was on June 12, 2020; the recruitment end date was October 6, 2020. The protocol was not submitted earlier because the enrollment of some patients took place after the closure of the recruitment on the clinicaltrials platform. In fact, due to the epidemiological conditions, due to the decrease of the cases in Argentina during the summer period, the recruitment stopped t before reaching the number of 140 patients (as indicated in the webpage). However, since there was a new increase in cases, the enrolment was resumed in order to reach the number of patients initially planned in the protocol. The final participant was recruited on February 14, 2021. ClinicalTrials.gov, number: NCT04403646 , registered on May 27th, 2020. The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol