Diagnóstico de infección tuberculosa latente: comparación de la prueba de tuberculina y el quantiferon-tb gold plus en contactos domiciliarios de la Ciudad de Buenos Aires

ResumenLa estrategia de control epidemiológico de la tuberculosis (TB) incluye tanto el diagnóstico y tratamiento precoz de los pacientesbacilíferos, como la identificación de aquellos con infección tuberculosa latente (ITBL) quienes representan el reservorio patógenoen la población.Objetivo: Comparar los resultados obtenidos utilizando la prueba de tuberculina (PPD) y el QuantiFERON-TB Gold Plus (QTF) en ungrupo de contactos domiciliarios de pacientes con TB pulmonar bacilífera, de la Ciudad de Buenos Aires. Se utilizaron dos puntos decorte para considerar la PPD positiva: ≥ 5 mm (PPD-5) y ≥ 10 mm (PPD-10).Materiales y métodos: Se extrajeron muestras de sangre para QTF en contactos domiciliarios de pacientes con TB bacilífera,seguido inmediatamente de la aplicación de PPD. Se consideró al QTF como la prueba de referencia a partir de la cual comparar laPPD calculando la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo (VPN) y coeficientede correlación Kappa.Resultados: Se incluyeron 48 contactos (33 mujeres, 69%), edad 38.8 ± 19 años, 27 (56%) argentinos, 18 (38%) bolivianos y 3(6%)peruanos, correspondientes a 37 casos de TB. Un solo contacto refirió no haberse aplicado la BCG, en 44 se objetivó la cicatriz. El QTFresultó positivo en 23 (47.9%) e indeterminado en 2 casos (4.2%). Excluyendo del análisis a los indeterminados, no hubo diferenciassignificativas entre contactos con QTF positivo y negativo al considerar la edad (33.8 ± 16 vs 42.1 ± 20 años), nacionalidad: argentinos(12 de 26, 46%) vs extranjeros (11 de 20, 55%) y sexo: mujeres (18 de 32, 56%) vs hombres (5 de 14, 36%).Utilizando PPD-5 hubo 28 (60.9%) positivos y 13 (28.3%) con PPD-10. Comparando PPD-5 vs PPD-10: S = 73.9 vs 34.8%, E = 52.2vs 78.3%, VPP = 60.1 vs 61.5% y VPN = 66.7 vs 54.5%. Los resultados coincidentes (positivos y negativos) entre QTF y PPD fueron29 (63%) para PPD-5 y 26 (56.5%) con PPD-10. Expresados con el coeficiente Kappa muestran concordancia débil (0.261) einsignificante (0.130), respectivamente.Conclusiones: considerando al QTF como el método de referencia por su mayor especificidad, la PPD-5, aunque menos específica,resultó más sensible que la PPD-10 para diagnosticar infección tuberculosa latente en el grupo de contactos domiciliarios estudiados.Fil: Gallego, Claudio. Hospital Piñero; ArgentinaFil: Amiano, Nicolás Oscar. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Armitano, Rita. Hospital Piñero; ArgentinaFil: Joza, Karla. Hospital Piñero; ArgentinaFil: Tateosian, Nancy Liliana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Muñoz, Luis. Hospital Piñero; ArgentinaFil: Poropat, Alejandra. Hospital Piñero; ArgentinaFil: Stupka, Juan Andrés. Hospital Piñero; ArgentinaFil: Salomone, César. Hospital Piñero; ArgentinaFil: García, Verónica Edith. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentin

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study

Introduction: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods: This is a post hoc study of the SPRiMACC study. It ́s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30&nbsp;days, and hospital stay ≤ 7&nbsp;days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes: 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion: Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Aportes para la Gestión Intersectorial

Fil: Juárez, A. Secretaría de Ambiente y Desarrollo Sustentable; Argentina.Fil: Segura, M. Secretaría de Ambiente y Desarrollo Sustentable; Argentina.Fil: González, A. Secretaría de Provincias; Argentina.Fil: Verrastro, O. Secretaría de Provincias; Argentina.Fil: Abraham, J. Secretaría de Política Económica; Argentina.Fil: Clot, M. Secretaría de Política Económica; Argentina.Fil: Sardi, R.I. Secretaría de Política Económica; Argentina.Fil: Asato, C.G. Servicio Geológico Minero Argentino; Argentina.Fil: Lapido, O. Servicio Geológico Minero Argentino; Argentina.Fil: Dall´Armellina, M. Subsecretaría de Planificación Territorial de la Inversión Pública; Argentina.Fil: Pomposiello, G. Subsecretaría de Planificación Territorial de la Inversión Pública; Argentina.Fil: Puricelli, G. Subsecretaría de Planificación Territorial de la Inversión Pública; Argentina.Fil: Romero, M.E. Subsecretaría de Planificación Territorial de la Inversión Pública; Argentina.Fil: Seiguer, H. Subsecretaría de Planificación Territorial de la Inversión Pública; Argentina.Fil: Abraham, M. Subsecretaría de Agricultura, Ganadería y Forestación; Argentina.Fil: Berthelot, M. Secretaría de Turismo; Argentina.Fil: Corral, A. Secretaría de Turismo; Argentina.Fil: Gallardo, C. Secretaría de Turismo; Argentina.Fil: Pelliza, V. Secretaría de Turismo; Argentina.Fil: Roberti, N. Secretaría de Turismo; Argentina.Fil: Rolón, C. Secretaría de Turismo; Argentina.Fil: Salomone, L. Secretaría de Turismo; Argentina.Fil: Aristimuño, A. Secretaría de Ambiente y Desarrollo Sustentable; Argentina.Fil: di Loreto, M. Secretaría de Ambiente y Desarrollo Sustentable; Argentina.Fil: Ortíz, Y. Secretaría de Ambiente y Desarrollo Sustentable; Argentina.Fil: Reichembach, A. Secretaría de Ambiente y Desarrollo Sustentable; Argentina.Fil: Villariño, R. Secretaría de Ambiente y Desarrollo Sustentable; Argentina.Fil: Franzese, G. Secretaría de Provincias; Argentina.Fil: Weich, M. Secretaría de Política Económica; Argentina.Fil: Longueira, S. Secretaría de Energía; Argentina.Fil: Pino, F. Secretaría de Energía; Argentina.Fil: Chalabe, N. Secretaría de Políticas Sociales y Desarrollo Humano; Argentina.Fil: Bermúdez, O. Secretaría de Ciencia, Tecnología e Innovación Productiva; Argentina.Fil: Grané, M. Secretaría de Empleo; Argentina.Fil: Carllinni, J. Subsecretaría de Gestión Pública; Argentina.Fil: Cerezo, M. Subsecretaría de Gestión Pública; Argentina.Fil: Pozzi, I. Subsecretaría de Gestión Pública; Argentina.Fil: Begenisic, F. Subsecretaría de Agricultura, Ganadería y Forestación; Argentina.Fil: Pascale, C. Subsecretaría de Agricultura, Ganadería y Forestación; Argentina.Fil: Foce, S. Subsecretaría de Desarrollo Urbano y Vivienda; Argentina.Fil: Rodríguez, E. Subsecretaría de Desarrollo Urbano y Vivienda; Argentina.Fil: Jovanovich, O. Subsecretaría de Planificación Territorial de la Inversión Pública; Argentina.Fil: Valente, G. Subsecretaría de Planificación Territorial de la Inversión Pública; Argentina.Fil: Marzioni, G. Subsecretaría de Tierras para el Hábitat Social; Argentina.Fil: Juliá, M. Subsecretaría de Recursos Hídricos; Argentina.Fil: Clot, M. Subsecretaría de Transporte Ferroviario; Argentina.Fil: Roccatagliata, J. Subsecretaría de Transporte Ferroviario; Argentina.Fil: Saller, V.H. Subsecretaría de Transporte Ferroviario; Argentina.Fil: Altuve, S. Instituto Nacional de Tecnología Agropecuaria (INTA); Argentina.Fil: Carrapizo, V. Instituto Nacional de Tecnología Agropecuaria (INTA); Argentina.Fil: Ligier, D. Instituto Nacional de Tecnología Agropecuaria (INTA); Argentina.Fil: Saucede, M. Instituto Nacional de Tecnología Agropecuaria (INTA); Argentina.Fil: Burkart, R. Administración de Parques Nacionales; Argentina.Fil: Bluske, G. Instituto Nacional de Estadísticas y Censos (INDEC); Argentina.Fil: Taddei, N. Instituto Nacional de Estadísticas y Censos (INDEC); Argentina.Fil: Vibes, J. Instituto Nacional de Estadísticas y Censos (INDEC); Argentina.Fil: Álvarez, P. Comisión Nacional de Actividades Espaciales; Argentina.Fil: Hernández, A.M. Comisión Nacional de Actividades Espaciales; Argentina.Fil: Goulart, H. Comisión Nacional de Energía Atómica (CNEA); Argentina.Fil: Oñate, M.S. Comisión Nacional de Energía Atómica (CNEA); Argentina

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

BackgroundLess invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.MethodThe S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.ResultsA 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications.ConclusionsThe Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.Trial Registration: ClinicalTrial.gov NCT04995380

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

Background: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. Methods: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. Results: SVR24 rates were 46.1 % (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1,2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced ≥1 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with ≥1 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not ≥5. Conclusions: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginter-feron alfa-2a/ribavirin

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or &gt;= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)