Diseño y desarrollo de un sistema de alerta temprana para pacientes hospitalizados por COVID-19

La pandemia por COVID-19 planteó un desafío para el sistema salud, debido a la gran demanda de pacientes hospitalizados. La identificación temprana de pacientes hospitalizados con riesgo de evolución desfavorable es vital para asistir en forma oportuna y planificar la demanda de recursos. El propósito de este estudio fue identificar las variables predictivas de mala evolución en pacientes hospitalizados por COVID-19 y crear un modelo predictivo que pueda usarse como herramienta de triage. A través de una revisión narrativa, se obtuvieron 44 variables vinculadas a una evolución desfavorable de la enfermedad COVID-19, incluyendo variables clínicas, de laboratorio y radiográficas. Luego se utilizó un procesamiento por método Delphi modificado de 2 rondas para seleccionar una lista final de variables incluidas en el score llamado COVID-19 Severity Index. Luego se calculó el Área Bajo la Curva (AUC) del score para predecir el pase a terapia intensiva en las próximas 24 horas. El score presentó un AUC de 0,94 frente a 0,80 para NEWS-2. Finalmente se agregó el COVID-19 Severity Index a la historia clínica electrónica de un hospital universitario de alta complejidad. Se programó para que el mismo se actualice de manera automática, facilitando la planificación estratégica, organización y administración de recursos a través de la identificación temprana de pacientes hospitalizados con mayor riesgo de transferencia a la Unidad de Cuidados Intensivos.Pandemics pose a major challenge for public health preparedness, requiring a coordinated international response and the development of solid containment plans. Early and accurate identifica tion of high-risk patients in the course of the current COVID-19 pandemic is vital for planning and making proper use of available resources. The purpose of this study was to identify the key variables that account for worse outcomes to create a predictive model that could be used effectively for triage. Through literature review, 44 variables that could be linked to an unfavorable course of COVID-19 disease were obtained, including clinical, laboratory, and X-ray variables. These were used for a 2-round modified Delphi processing with 14 experts to select a final list of variables with the greatest predictive power for the construction of a scoring system, leading to the creation of a new scoring system: the COVID-19 Severity Index. The analysis of the area under the curve for the COVID-19 Severity Index was 0.94 to predict the need for ICU admission in the following 24 hours against 0.80 for NEWS-2. Additionally, the digital medical record of the Hospital Italiano de Buenos Aires was electronically set for an automatic calculation and constant update of the COVID-19 Severity Index. Specifically designed for the current COVID-19 pandemic, COVID-19 Severity Index could be used as a reliable tool for strategic planning, organization, and administration of resources by easily identifying hospitalized patients with a greater need of intensive care.Fil: Huespe, Ivan. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Hospital Italiano. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional E Ingenieria Biomedica.; ArgentinaFil: Carboni Bisso, Indalecio. Hospital Italiano; ArgentinaFil: Gemelli, Nicolas A.. Hospital Italiano; ArgentinaFil: Terrasa, Sergio Adrian. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Di Stefano, Sabrina. Hospital Italiano; ArgentinaFil: Burgos, Valeria Laura. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Hospital Italiano. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional E Ingenieria Biomedica.; ArgentinaFil: Sinner, Jorge. Hospital Italiano; ArgentinaFil: Oubiña, Mailen. Hospital Italiano; ArgentinaFil: Bezzati, Marina. Hospital Italiano; ArgentinaFil: Delgado, Pablo. Hospital Italiano; ArgentinaFil: Las Heras, Marcos. Hospital Italiano; ArgentinaFil: Risk, Marcelo. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Hospital Italiano. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional E Ingenieria Biomedica.; Argentin

Diseño y desarrollo de un sistema de alerta temprana para pacientes hospitalizados por COVID-19

La pandemia por COVID-19 planteó un desafío para el sistema salud, debido a la gran demanda de pacientes hospitalizados. La identificación temprana de pacientes hospitalizados con riesgo de evolución desfavorable es vital para asistir en forma oportuna y planificar la demanda de recursos. El propósito de este estudio fue identificar las variables predictivas de mala evolución en pacientes hospitalizados por COVID-19 y crear un modelo predictivo que pueda usarse como herramienta de triage. A través de una revisión narrativa, se obtuvieron 44 variables vinculadas a una evolución desfavorable de la enfermedad COVID-19, incluyendo variables clínicas, de laboratorio y radiográficas. Luego se utilizó un procesamiento por método Delphi modificado de 2 rondas para seleccionar una lista final de variables incluidas en el score llamado COVID-19 Severity Index. Luego se calculó el Área Bajo la Curva (AUC) del score para predecir el pase a terapia intensiva en las próximas 24 horas. El score presentó un AUC de 0,94 frente a 0,80 para NEWS-2. Finalmente se agregó el COVID-19 Severity Index a la historia clínica electrónica de un hospital universitario de alta complejidad. Se programó para que el mismo se actualice de manera automática, facilitando la planificación estratégica, organización y administración de recursos a través de la identificación temprana de pacientes hospitalizados con mayor riesgo de transferencia a la Unidad de Cuidados Intensivos.Pandemics pose a major challenge for public health preparedness, requiring a coordinated international response and the development of solid containment plans. Early and accurate identifica tion of high-risk patients in the course of the current COVID-19 pandemic is vital for planning and making proper use of available resources. The purpose of this study was to identify the key variables that account for worse outcomes to create a predictive model that could be used effectively for triage. Through literature review, 44 variables that could be linked to an unfavorable course of COVID-19 disease were obtained, including clinical, laboratory, and X-ray variables. These were used for a 2-round modified Delphi processing with 14 experts to select a final list of variables with the greatest predictive power for the construction of a scoring system, leading to the creation of a new scoring system: the COVID-19 Severity Index. The analysis of the area under the curve for the COVID-19 Severity Index was 0.94 to predict the need for ICU admission in the following 24 hours against 0.80 for NEWS-2. Additionally, the digital medical record of the Hospital Italiano de Buenos Aires was electronically set for an automatic calculation and constant update of the COVID-19 Severity Index. Specifically designed for the current COVID-19 pandemic, COVID-19 Severity Index could be used as a reliable tool for strategic planning, organization, and administration of resources by easily identifying hospitalized patients with a greater need of intensive care.Fil: Huespe, Ivan. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Hospital Italiano. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional E Ingenieria Biomedica.; ArgentinaFil: Carboni Bisso, Indalecio. Hospital Italiano; ArgentinaFil: Gemelli, Nicolas A.. Hospital Italiano; ArgentinaFil: Terrasa, Sergio Adrian. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Di Stefano, Sabrina. Hospital Italiano; ArgentinaFil: Burgos, Valeria Laura. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Hospital Italiano. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional E Ingenieria Biomedica.; ArgentinaFil: Sinner, Jorge. Hospital Italiano; ArgentinaFil: Oubiña, Mailen. Hospital Italiano; ArgentinaFil: Bezzati, Marina. Hospital Italiano; ArgentinaFil: Delgado, Pablo. Hospital Italiano; ArgentinaFil: Las Heras, Marcos. Hospital Italiano; ArgentinaFil: Risk, Marcelo. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Hospital Italiano. Instituto de Medicina Traslacional E Ingenieria Biomedica. - Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional E Ingenieria Biomedica.; Argentin

Optimizing dialysis dose in the context of frailty: an exploratory study

Introduction Frailty is a multicausal syndrome characterized by a decrease in strength, resistance and physiological function, which makes the individual vulnerable and dependent, and increases his/her mortality. This syndrome is more prevalent among older individuals, and chronic kidney disease patients, particularly those on dialysis. Dialysis dose is currently standardized for hemodialysis (HD) patients regardless of their age and functional status. However, it has been postulated that the dialysis dose required in older patients, especially frail ones, should be lower, since it could increase their degree of frailty. Then, the purpose of this study was to evaluate if there would be a correlation between the dose of Kt/V and the degree of frailty in a population of adult patients on HD. Materials and methods A cross-sectional study with 82 patients on HD in Barranquilla (Colombia) and Lobos (Argentina) was conducted. Socio-demographic and laboratory data, as well as dialysis doses (Kt/V) were recorded and scales of fragility, physical activity, gait and grip strength were applied. Then these data were correlated by a Spearman’s correlation and a logistic regression. Results CFS, social isolation, physical activity, gait speed, and prehensile strength tests were outside the reference ranges in the studied group. No significant correlation was found between dialysis dose and all the above mentioned functional tests. However, a significant and inverse correlation between physical activity and CFS was documented (score − 1.41 (CI − 2.1 to − 0.7). Conclusion No significant correlation was documented between Kt/V value and different parameters of the frailty status, but this status correlated significantly and inversely with physical activity in this group. Frailty status in hemodialysis patients was significantly higher in older individuals, although young individuals were not exempt from it

Activismo y garantismo procesal

Fil: Álvarez Gardiol, Ariel. Academia Nacional de Derecho y Ciencias Sociales de Córdoba; Córdoba, ArgentinaFil: Peyrano, Jorge W. Academia Nacional de Derecho y Ciencias Sociales de Córdoba; Córdoba, Argentina.Fil: Barberio, Sergio José. Universidad Nacional del Litoral; Santa Fe, Argentina.Fil: Meroi, Andrea A. Universidad Nacional de Rosario. Facultad de Derecho; Rosario, Argentina.Fil: Banabentos, Omar A. Universidad Nacional de Rosario. Facultad de Derecho; Rosario, Argentina.Fil: Terrasa, Eduardo. Universidad Nacional de Rosario. Facultad de Derecho; Rosario, Argentina.Fil: García Montaño, Tristán. Tribunal de Arbitraje del Colegio de Abogados de Rosario; Rosario, Argentina.Desde los grandes sistemas de la filosofía helénica, el derecho ha ocupado un lugar importante en la preocupación especulativa. Toda la filosofía del derecho, desde sus más remotos y venerables inicios hasta ya comenzado el siglo XVIII ha sido derecho natural que, así como en la antigüedad giraba en torno a la oposición entre naturaleza y norma (physis y nomos), en el Medioevo se preocupó por la relación existente entre el derecho divino y el derecho humano, inquietud que se transfirió en la modernidad, a la oposición entre la coacción jurídica y la razón individual. Los sistemas filosóficos de Hegel y Kant fueron las dos últimas grandes estructuras especulativas que incorporaron al derecho como una porción, no menor, de sus importantísimas arquitecturas de pensamiento, en las que el derecho ocupó una posición dominante. A partir de ello, el derecho padeció en los sistemas que les sucedieron una de las condenas más penosas: la del olvido. Ninguno de los filósofos generales que sobrevinieron al idealismo alemán incorporó al derecho como una parte de la totalidad de sus teorías. Jürguen Habermas, tal vez, el representante más sobresaliente de la segunda generación de filósofos de la escuela de Frankfurt, gran figura del pensamiento europeo contemporáneo y padre del patriotismo constitucional, ha sido el primer filósofo general que ha reinstalado el derecho en su sistema de jusfilosofía política. Habermas propone como parte de su teoría general del derecho en Ciencia y facticidad (1998), tal vez una de sus obras más logradas, el paradigma jurídico o procedimental discursivo, jerarquizando así el procedimiento y el discurso como los atributos esenciales de la juridicidad. En el caso de las formulaciones teóricas, el activismo judicial y el garantismo procesal no son en realidad paradigmas porque para ser tal, requiere del reconocimiento de toda la comunidad científica y esto, obviamente, no se da en nuestro caso. En el ámbito de la ciencia jurídica, los únicos paradigmas incontrovertibles que tienen su origen en el mundo griego y nos vienen casi desde la Antígona de Sófocles, son el jusnaturalismo y el juspositivismo, que han dominado en ámbitos estatutarios muy fuertemente y han pasado por momentos de absoluta intolerancia, hasta llegar a esta serena meseta de respetuosa y casi amable convivencia por la que hoy se transita

Tips for Writing a Scientific Article. Part 2: The Sections of the Article

The writing of academic articles is a necessary competence for the dissemination of scientific knowledge and for the professional development of those who work in various disciplines. However, despite its importance, this complex skill is not usually taught in a systematic way, which can act as a barrier for researchers to communicate the results of their work. In the first part of this article, the authors summarized the main advice provided by experts on the subject, adding some of their personal experience that they consider useful to facilitate the process of academic writing and the development of this competence in a collaborative context. In this second part, they delve into the problems of writing the different sections of a scientific article and offer advice to optimize it and make it as effective as possible

Smoking rates among students of medicine at a University Institute in Buenos Aires: Cross section-study

Introducción: Argentina tiene una tasa de tabaquismo en adultos del 22,1%. Estudios previos han mostrado que los estudiantes de Medicina fuman al mismo nivel que la población general. El estatus tabáquico de los médicos afecta su capacidad para brindar consejo anti-tabáquico.Métodos: Estudio observacional de corte transversal. En 2011 se administró una encuesta a los estudiantes de Medicina del Instituto Universitario del Hospital Italiano de Buenos Aires preguntando sobre características demográficas, características de consumo de tabaco, y conocimiento y actitudes hacia el tabaquismo.Resultados: Se entrevistaron 217 estudiantes (tasa de respuesta: 97,7%). De ellos, 58,1% concurrían al ciclo inicial de la carrera y 41,9%, al ciclo final; 63 (29%) eran fumadores actuales. Menos fumadores actuales estuvieron de acuerdo con la prohibición de fumar en espacios cerrados tales como restaurantes, bares y escuelas (88,9% vs 97,4%, P=0,034). El 68,7% de los encuestados (98,9% entre los alumnos avanzados) afirmó haber recibido instrucción sobre cesación tabáquica. Sin embargo, 41,5% no reconoció la utilidad de la terapia de reemplazo nicotínico para dejar de fumar, y sólo el 11,1% refirió conocer el Programa de Intervención Breve Anti-tabáquica. El 60,4% manifestó querer recibir mayor información sobre tabaquismo.Conclusión: Los estudiantes de Medicina del Hospital Italiano fuman al mismo nivel que la población general. Si bien la mayoría recibe información sobre estrategias de cesación a lo largo de la carrera, la misma parecería ser insuficiente.Introduction: Argentina has a smoking rate among adults of 22.1%; previous research has shown medical students smoke at the same rate than the general population. Physicians’ smoking status affects their ability to provide anti-smoking advice. Methods: Observational cross-sectional study. In 2011 a survey was administered to medical students at Hospital Italiano de Buenos Aires School of Medicine asking about demographic and tobacco use characteristics, and knowledge and attitudes toward smoking. Results: 217 students were interviewed (response rate: 97.7%). Of these, 58.1% were in the school’s initial years, and 41.9% in the latest ones; 63 (29%) were current smokers. Current smokers were less likely to agree with a smoking ban in enclosed spaces such as restaurants, bars and schools (88.9% vs 97.4%, P=0.034); 68.7% of respondents referred having received training on smoking cessation (98.9% among advanced students). However, 41.5% did not acknowledge the utility of nicotinic replacement therapy for smoking cessation, and only 11.1% knew about anti-smoking brief interventions. 60.4% wanted to receive more information about smoking. Conclusion: Medical students at the Hospital Italiano smoke at the same rate than the general population. Although most have received some information on cessation strategies, it is insufficient.Fil: Gonzalez, Lucas Elio. Gobierno de la Ciudad de Buenos Aires. Hospital de Emergencias Psiquiátricas "Torcuato de Alvear"; ArgentinaFil: Lescano, Nicolas A.. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Dr. Enrique Tornú; ArgentinaFil: Terrasa, Sergio Adrian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; Argentina. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Salgado, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; Argentin

Child and Teenage Screen Exposure: Recommendations, Limits, and Controversies in the Context of Enforced Social Distancing. A Qualitative Study

Introduction: screen use during childhood and potential harm concerns have increased in recent years. Advice not to allow more than two hours of screen use per day was contested during the COVID-19 pandemic. The primary purpose of this research was to probe the opinions and attitudes of professionals regarding the use of screens and to understand how these changed during the pandemic. Materials and methods: this exploratory study, with a cualitative approach and theory-based strategy, was made between 2020 and 2021, and involved the participation of 23 professionals (pediatricians and general practitioners) in four focus groups.The recorded material was analyzed for content interpretation. The analysis included generating codes that were grouped into five thematic areas. Results: the resulting axes were: 1) the issue of screens in the outpatient practice of healthy children; 2) perception of harm; 3) perception of benefits; 4) screens in times of Preventive and Compulsory Social Isolation (ASPO, for its acronym in Spanish); and 5) contradictory thoughts and actions on the use of screens. Discussion: when making recommendations regarding screen exposure, the interviewees' intuition predominated over available scientific evidence. They recognized that the ASPO context highlighted some of the benefits associated with the connectivity provided by these devices. Conclusion: our results show that awareness of screen displays is becoming increasingly neutral concerning the trade-off between their risks and benefits, prompting practitioners to become more flexible in their recommendations

The evolutionary history of Mediterranean Batoidea (Chondrichthyes: Neoselachii)

Batoidea (rays, skates and their relatives) is the largest group included in the subclass Elasmobranchii. Mediterranean Batoidea fauna is relatively diverse, characterised by a history of isolation and connectivity resulting from tectonic movements and changes in ocean circulation. The evolutionary histories of Batoidea species in the Mediterranean were estimated from two mitochondrial markers (COI and NADH2) through dating and Bayesian analyses. Additionally, two species delimitation analyses (Poisson Tree Process and General Mixed Yule Coalescent) were conducted to elucidate species boundaries. The relationship between Raja species—their ecological traits and species level phylogeny—was also studied to understand speciation in this genus. Results concerning the phylogenetic relationship between Batoidea species were largely consistent with recent molecular studies. Divergence times show a parallel evolutionary history of Batoidea fauna and Mediterranean history, which began from the Triassic. Three important speciation events were detected (a) throughout the Jurassic, when the major lineages were split (b) at the Eocene–Oligocene, when almost all genera of Batoidea were branched, and (c) during the Miocene, when almost all current species of Batoidea derived. These diversification events correspond to crucial paleoclimatic and paleogeographical events that took place at the global and local scale. Phylogenetic and species delimitation analyses revealed the presence of 18 species. Raja species showed different ecological preferences related to depth and habitat, which indicated a genus speciation process driven by different habitat characteristics

Demersal chondrichthyans in the western Mediterranean: assemblages and biological parameters of their main species

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