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The aim of this paper was to provide quantitative data about clinical investigation in Argentina. We searched MEDLINE which is the U.S. National Library of Medicine's bibliographic database that contains more than 18 million references to journal articles in life sciences; 5400 journals in 39 languages are listed. In 2009 almost 850,000 papers were cited in MEDLINE and Argentina provided 0.33% of them, 90% of these in English. The number of papers published in Spanish is diminishing every year and similar results are observed with the German, French and other languages. Using the tools provided by MEDLINE we searched for papers that could be classified as clinical. We restricted our search to the word "patients" in the text and "hospital" in the address provided by the authors. Along the last 10 years, from 2000 to 2009, about 16% of the papers published from Argentina contain the word "patient" and this percentage is reduced to half if we combine the word "patient" with the word "hospital" in the address. If we search for papers written in Spanish with these two restrictions the number is much lower. The number of articles from Argentina followed the upward trend in the total of articles cited in MEDLINE in the last 10 years. This local increase was due to basic investigation papers because the percentage of clinical articles was relatively constant during these years. In conclusion, these data provide a survey of an area with scanty quantitative information.

Parents who decide to change the usual diet of their children for a more restrictive one should know the risks and advantages of the chosen diet and receive information that helps them to offer their children a sufficient diet. Vegetarian diets can be adopted as long as they are planned by specialists with the inclusion of a wide variety of plant foods and fortified foods with the appropriate supplementation indicated at each stage. The objective of this document is to present the position of the Nutrition Committee of the Argentine Society of Pediatrics and to provide health professionals with adequate information to respond to the concerns of parents and patients who decide to choose a vegetarian diet as a modality of feeding. The challenges to betaken into account are identified, highlighting that without these considerations and proper monitoring these diets cannot be carried out safely in childhood., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Introduction: Critical congenital heart disease (CCHD) is a term that refers to ductus-dependent structural anomalies of the heart that may be fatal or require invasive management in the first month of life., Objective: To know the prevalence and distribution of CCHD among newborns in Argentina, compared to other countries, and the proportion of prenatal detection and perinatal mortality., Material and Methods: Data provided by the National Network of Congenital Anomalies (Red Nacional de Anomalías Congénitas de Argentina, RENAC) for the 2009-2018 period and by other surveillance systems in the United States, Europe, and Colombia were used. For Argentina, the proportion of prenatal detection, perinatal mortality, and CCHD prevalence in newborns by jurisdiction and health system subsector were analyzed., Results: The prevalence of CCHD was 11.46 (95% confidence interval: 11.02-11.92) every 10 000 births. Prenatal detection was possible in 43.93% of cases, and perinatal mortality was 25%. Tetralogy of Fallot was the most frequent specific defect. The prevalence of CCHD and percentage of prenatal detection was significantly lower in the public subsector, whereas perinatal mortality was higher in this subsector. The prevalence of CCHD was lower than in the United States (NBDPN) and European (EUROCAT) registries. The Bogotá Registry showed different specific prevalence values., Conclusion: The prevalence of CCHD is lower than what has been observed in other countries, and even lower in the public sector of Argentina. The need to improve prenatal detection and implement pulse oximetry among newborns as a mandatory and universal screening is emphasized.

Acute lower respiratory infections (ARI) continue being an important cause of morbidity and mortality in our region. Standardized case management is a valuable tool to deal with them. In addition to aspects related to the diagnosis and treatment of these diseases, the analysis of risk factors (both biological and socio-environmental) from a local and current perspective, allows the implementation of effective control and/or prevention measures, as well as identifying those patients susceptible to presenting serious forms or complications. Since 1996, the Sociedad Argentina de Pediatría asumed the challenge of generating a document that guides the comprehensive management of patients with ARI. This fourth update includes the latest advances on the subject., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Introduction: Indigenous peoples are undergoing profound Lifestyle changes that affect their health and the way they manage their diseases. The objective of this study was to determine the therapeutic itineraries followed by Qom mothers whenever they perceive their children are sick., Population and Methods: The study was done in the Namqom peri-urban community, in the province of Formosa, with a group of mothers with young children interviewed at their houses until achieving saturation. The study followed an exploratory, qualitative design based on a conceptual health belief model., Results: The therapeutic itineraries selected by 16 Qom mothers included using home remedies, biblical/faith healing, healers, and visiting the provincial health center. In general, the itinerary depends on how the mother characterizes disease symptoms: natural (biological cause) or unnatural (sorcery-related). The different methods are not necessarily incompatible and, many times, are used as complementary. Both reliability on effectiveness and fear of consequences play an important role on treatment selection. These results are extremely helpful to improve the dialog between the community and the health center. It is necessary to promote an improved coordination among the different health care agents working in transitioning indigenous communities., Conclusions: The results of this study described selected therapeutic itineraries and, as a consequence, evidenced the strong presence of pluralistic medical systems in this community., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Este artículo analiza la cobertura mediática del avance de la pandemia de Covid-19 en Argentina y la medida de aislamiento social preventivo y obligatorio decretada por el gobierno nacional. Destaca tendencias problemáticas y buenas prácticas según un enfoque teórico-normativo, y las vincula con las características históricas del sistema de medios en el país. Utiliza una perspectiva teórico-metodológica que concibe a la comunicación como un derecho humano fundamental, esencial en una sociedad democrática y a los medios de comunicación de masas como vehículo fundamental para su ejercicio, y se apoya en las recomendaciones formuladas por organismos internacionales, organizaciones de la sociedad civil e instituciones nacionales. Se sostiene que los medios de comunicación de masas en la Argentina tienen la oportunidad histórica de mostrar la relevancia de su aporte no sólo para que enfrentar esta coyuntura, sino también para que salgamos de ella como una sociedad mejor y más justa., (Universidad Nacional de Córdoba)

Introduction: The World Health Organization recommends prioritizing safe and effective drugs proven by clinical or epidemiological studies. However, in population groups with little research, a drug can be used for an indication or pharmaceutical form different from that approved by the regulatory agency (off-label), extrapolating data from studies in adults and exposing pediatric patients. to develop an Adverse Drug Reaction (ADR) due to safety considerations that have not been systematically studied. Intravenous immunoglobulin (IVIg), a high-cost drug, is used with scant evidence in some low-prevalence pathologies. This paper describes and analyzes the off-label use of IVIg at the J. P. Garrahan Pediatric Hospital., Methods: Observational, descriptive, prospective study on off-label indications of IVIg. The sampling technique was non-probabilistic and for convenience during 7 months., Results: 305 IVIg infusions were studied, corresponding to 111 patients. The indication classification showed that 22% (n=67) of the infusions were off-label. In neurology there was a higher percentage of off-label indications (46%) and within them 45% corresponded to the use in neurological disorders. 81% of the doses indicated off-label were in the range 0.8-1g/kg. The off-label infusions presented 61.5% (n=8) of the ADRs. Those from the Neurology service represented 87.5%; 75% being from the "Neurological disorders" group., Conclusion: In some cases, IVIg was indicated in an off-label manner, finding a statistically significant relationship with the appearance of ADR. This finding motivates the proposition of new hypotheses to carry out more studies., (Universidad Nacional de Córdoba)

This paper examines the significant contribution of Dr. Valentín Grandis and Dr. Virgilio Ducceschi to the founding and development of experimental physiology at the Faculty of Medical Sciences of the National University of Córdoba (UNC), Argentina. Although the most notable contribution to the field of experimental physiology in Argentina is attributed to Bernardo Alberto Houssay, this study highlights the importance of the previous and fundamental efforts of Grandis and Ducceschi, two Italian professors whose work in Buenos Aires and Córdoba laid the foundations for research and teaching in this discipline. The paper details how, in 1904, the arrival of Valentin Grandis at the UNC marked the formal beginning of the teaching and practice of experimental physiology at the institution, followed by the incorporation of Virgilio Ducceschi, who continued and expanded Grandis' legacy. The work of these two Italian masters involved not only the installation of a state-of-the-art laboratory but also the establishment of a solid academic and scientific foundation that would influence future generations of Argentine physicians and researchers. Through a detailed analysis of their biographies, scientific contributions, and the impact of their work, this paper illustrates how Grandis and Ducceschi were key figures in the development of medical science in Argentina, particularly in the field of experimental physiology. Furthermore, the study highlights the importance of their educational approach and their ability to train disciples who would continue their research, thus ensuring the permanence of their legacy at the National University of Córdoba and in Argentine science in general. In conclusion, this paper vindicates and celebrates the contributions of Valentín Grandis and Virgilio Ducceschi to the initiation of research and experimentation in physiology and biological chemistry at the UNC, highlighting their importance in the advancement of medicine and science in Argentina., (Universidad Nacional de Córdoba)

The European-Latin American Consortium towards Eradication of Preventable Gallbladder Cancer (GBC) - EULAT Eradicate CVB is collecting high-quality data and samples in four Latin American countries with a high incidence of GBC: Argentina, Bolivia, Chile and Peru. The goal is to build a unique biorepository integrated with a customized informatics platform, identify, validate, and functionally characterize novel GBC risk biomarkers, and develop GBC prediction models integrating epidemiological and genetic-molecular risk factors. We decided to develop the electronic data collection application EULAT eCollect to facilitate the retrieval of socio-demographic, clinical, lifestyle, nutritional, and sample information from the 15,000 Latin Americans we are enrolling. The EULAT eCollect app reduces the time spent by study participants, limits the use of paper and ink, minimizes the costs and errors associated with completing written forms and their subsequent digitization, and allows close monitoring of local recruitment rates and data quality. We describe in this article the design and implementation of EULAT eCollect, which started with the specification of functional and non-functional requirements and ended with the implementation and subsequent validation of the four application modules: I Socio-demographic interview, II Sample information, III Case report form, and IV Food frequency questionnaire. We present both general and technical results and our experience with the Open Data Kit software, which may be of interest for future research projects, especially those on personalized cancer prevention conducted in low- and middle-income regions.

Literature concerning patients with Treatment-Resistant Depression (TRD) treatment response and patient report outcomes (PROs) -such as QoL or disability- in Argentina is scarce. In the scope of the Treatment-Resistant Depression in America Latina (TRAL) study which previous results highlighted the burden of TRD compared to non-TRD patients as well as essential epidemiological data in the region, this paper reports on the outcomes of Standard-of-Care (SOC) over a 1-year follow-up of TRD patients in the subsample for Argentina. From a sample of 220 MDD patients identified in 5 sites in Argentina, 72 patients were diagnosed with TRD. Exclusion criteria included patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial. MADRS, PHQ-9 and PROs (EQ-5D and SDS) were used as outcomes. Patients’ mean age was 54.7 years and 70.3% of the patients were female. Around 61% of the patients achieved a response (reduction of MADRS score ≥ 50%), but over 33% did not achieve a remission (MADRS total score ≤12). Almost 67% of the patients still felt anxious/depressed at the end of the study (EQ-5D), while disruption affected patients in diverse areas -71% in work/school, 69.7% in social life/leisure and 66.6% in their family life/personal responsibilities. The burden of TRD is significant in Argentina, and more effort should be put in the implementation of treatment protocols with better outcomes., (CC BY NC ND)

We are currently witnessing a renaissance of psychedelic science in clinical research. In Argentina, the challenges related to its study and the development of new treatments in the field of Psychiatry are subject to the adoption of certain regulatory policies. The evolution of the knowledge about the effects, mechanisms of action and therapeutic potential of serotonergic psychedelics warrants a change in the regulatory framework for their use in clinical research. In a world that demands rapid flexibility and adaptation, we should avoid waiting for advances from developed countries. It is evident that psychopharmacological progress in the last thirty years have not been up to the expectations of the so-called "decade of the brain". Aware of these limitations, in this paper we carry out a historical and ethnopharmacological review of the classic psychedelics, from the 50's to the present -without ignoring their ancestral uses-, in order to highlight the political and cultural controversies that these molecules have raised in the field of Psychiatry. We hope to promote in the local environment an approach devoid of stigmas and that considers the therapeutic potential of these substances, with the ultimate goal of providing relief to severe mental illnesses that to this day continue to remain unanswered., Competing Interests: The author declare no conflict of interest

In the paediatric population, paticulary in the field of child and adolescent psychiatry, off-label indications are the rule rather than the exception. This may occur when a drug is indicated for a pathology, age, route of administration or treatment length other than those described in the product label. Argentina, unlike other countries, has no explicit regulation on off-label prescribing. Therefore, the prescription of a medicine in a manner different from that approved by the National Administration of Medicines, Food and Medical Technology (ANMAT) does not have a regulatory framework regarding the conditions that must be met at the time of treatment. Although off-label use is not prohibited, it carries an additional risk. In order to encourage research in paediatrics, regulatory agencies such as the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have introduced legislative reform. The following paper will review the current framework of the regulatory agencies that are relevant to the paediatric population and will analyse criteria to guide physicians in the rational use of off-label pharmacotherapy., Competing Interests: The authors have no conflicts of interest to declare., (Creative Commons BY-NC-ND 4.0)

Introduction: Housing is one of the main supports needed to guarantee community life of people who had long-term psychiatric hospitalizations. In Argentina, housing support experiences have been developed for decades, although their systematization is scarce. The objective of this paper is to describe three housing support experiences developed in the province of Buenos Aires, Argentina, which have continuity over time for more than 20 years., Materials and Methods: Document analysis and interviews with workers from the three experiences were carried out, as part of a broader project on community life and neighborhood relations of people discharged after long-term psychiatric hospitalizations. The material was analyzed qualitatively, using a time dimension and a structure and functioning one which included financing, technical resources, housing devices and support provided., Results: Although the types of support provided are somehow similar between the three experiences, heterogeneity in structure and functioning is observed., Discussion and Conclusions: Despite the fact that the human rights framework proposes the provision of flexible and adequate support according to the needs of people, it is worth reflection on whether the reduced systematization of experiences such as those presented is due to the difficulties of the heterogeneity mentioned, or is due to a scarce evaluation culture that obstacles the learning from those experiences.

Treatment-Resistant Depression (TRD) prevalence varies considerable between regions and epidemiology of TRD in Argentina is lacking. Based on the Treatment-Resistant Depression in America Latina (TRAL) study, epidemiology and burden of TRD in MDD patients from Argentina is reported in this paper. A sample of adult MDD patients (n=396) from 5 sites in Argentina, with clinical diagnosis were included. Patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial were excluded. Patient reported outcomes and clinical assessment scales were used as outcomes. The prevalence of TRD in MDD patients in Argentina is 33.2%, based on TRAL data. Patients in TRD are older compared to those without TRD, and was more evident in married/consensual union MDD patients. Higher suicidality, greater comorbidity based on MINI, and worse scores in MADRS and PHQ-9 were identified in TRD patients. The prevalence identified in TRAL study for Argentina is substantial comparing with other Latin American countries and worldwide prevalence. TRD represents a disproportional burden to society, and efforts should be placed on reducing the burden of MDD and TRD in Argentina by improving early diagnosis, therapeutic management and ensuring that all patients have better access to mental healthcare.

Direct oral anticoagulants have emerged as the drugs that have changed the management of the antithrombotic treatment in the last 15 years. Their advantages, like a more friendly way of anticoagulation and their lower risk of bleeding, especially in the brain, have positioned these new anticoagulants as the first drug of choice in the two most frequent indications of anticoagulation, atrial fibrillation, and the venous thromboembolic disease. However, not all the patients can receive these agents, not all the direct oral anticoagulants have the same characteristics, and most importantly, not all the diseases with an indication of an anticoagulant drug can be treated with them. Therefore, it is mandatory that all the faculties involved in the management of these drugs must know them in depth, to decide the best treatment for the patient. This position paper, from a group of experts in anticoagulation in Argentina, can help the general practitioner in the daily use of direct oral anticoagulants based on the new evidence and the experience of a wide group of professionals. The way we relate to the anticoagulant treatment has changed in the last years. The doctors who work with them must also do so.

Introduction: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient's usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment., Aim: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia., Materials and Methods: Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia., Results: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia., Conclusions: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.

The implementation of electronic medical record tools in pediatric care implies the creation of use recommendations and a clear definition of functional features. The objective of this paper is to describe minimum specific functionalities for an electronic medical record in pediatrics, with the aim to contribute to a definition of design criteria and best practices for its use. In this report, we will go over the generic functionality of the electronic medical record; we will frame the legal context in Argentina; we will approach some implementation aspects; and finally, we will describe minimum pediatric specific functionalities. Despite the adoption barriers in the field of pediatrics when it comes to incorporating electronic medical records into their professional activity, there are multiple resources to enable this digital transformation process. It is also fundamental to understand that, like any other technology, there are responsibilities related to their appropriate use., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Azospirillum brasilense Az39 has been used since more than 30 years by several companies in South America for biofertilizers production. This strain may promote plants growth and development, as well as the ability of inoculated plants to tolerate environmental stresses, which determines an increase in the productivity under field conditions. At present, there are no protocols in Argentina to confirm the identity of Az39 in commercial products; however, such biofertilizers are formulated almost exclusively with this strain. Therefore, the objective of this paper was to develop a molecular methodology that allows the accurate identification of A. brasilense Az39. Using the complete genome sequence and several bioinformatics tools, fragments of DNA present only in the Az39 genome were recognized. A set of PCR primers to amplify these sequences were designed, and the specific products were observed only in the strain of our interest. The sensitivity of the methodology was evaluated, where the strain could be detected up to a titer of 10 5 CFU/ml (4.5 ng/μl ADN) or 10 2 CFU/ml (0.88 ng/μl DNA) or in a minimal concentration of 0.098 ng/μl DNA, depending on the DNA extraction methodology used. Primers were tested against direct samples of commercial inoculants and cultures, in both cases there were specifics products, both in direct samples and in confirmatory tests from isolated colonies from those products. The procedure presented in this paper allows the accurate identification of A. brasilense Az39 in pure cultures, mixtures of microorganisms, and commercial biofertilizers., (Copyright © 2019 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Autoimmune encephalitis refers to a group of pathologies described in the last two decades, characterized by neuropsychiatric symptoms of subacute presentation, mediated by antibodies directed against neuronal membrane proteins. Within this group, encephalitis mediated by antibodies against the NMDA receptor of glutamate is a particular clinical entity, given that its expression is dominated by psychiatric symptoms that usually occur at the onset of the disease. In this paper we describe five cases of NMDA encephalitis in adult patients followed up in the last four years in a public hospital in the City of Buenos Aires, Argentina. We also include a review of the current literature. We emphasize the clinical description of the psychiatric symptoms of presentation, since these lead to the patient's first contact with the health system. Given the difficulty in our environment to implement the determination of autoantibodies, the ability to clinically recognize this pathology becomes paramount to establish an early preliminary diagnosis and not to delay immunosuppressive therapy, thus allowing for a better prognosis.

Introduction: Argentine science has played an important role in the study of blood pressure. However, this scientific production has not been classified. We set out (1) to analyse the contribution of scientific publications indexed in MEDLINE of authors with Argentinean academic affiliation in the field of blood pressure and hypertension in the last 50 years and, (2) determine the characteristics of the scientific journals in which they were published., Methods: The 831 indexed MEDLINE publications by authors from Argentina were analysed quantitatively and qualitatively (period 1966-2017)., Results: The number of publications has increased 5.4 times in the last 20 years. Eighty percent of the publications were original manuscripts and 15% reviews. Sixty-five percent of the publications addressed clinical research, 33% basic research. The average authors per paper was 6 (89% as first author), 74% belonged to public institutions. The research was published in journals published in the United States (36%), the United Kingdom (27%), the Netherlands (12%), Spain (6%) and Argentina (4%). Eighteen percent of the publications were in journals with impact factor >3.88 (first quartile). Only 5% accessed journals with a factor ≥10. The average SJR index was 1.66., Conclusions: Argentine scientific production in MEDLINE in the field of blood pressure and hypertension showed constant growth. The vast majority is original research, directed by researchers with affiliation to public institutions. Foreign journals are accessed in the main, with acceptable quality indexes., (Copyright © 2019 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

The present paper analyzes, in the context of a settlements' relocation, the participation and tactics developed by the Barrio Nuevo inhabitants and doctors of a Health Centre in La Plata (Argentina), to face the crisis that is taking place in the country from the application of austerity policies. Our assumption is that community participation and in health issues (understood in a holistic sense) makes it possible to identify and intervene in social conditions, such as the right to the city, to produce changes in the health situation of the territory. For this, we will investigate the crisis, the current public policies and the modes of participation. Specifically, we will develop the experience of a Health Situation Analysis (ASIS) held in the territory and we will analyze the relationship between the right to health and the right to the city.The methodology used is ethnography. We carried out participant observations, in-depth interviews, a health workshop and participated in the ASIS.We conclude that there is a dialectical relationship between the right to the city and to health and this is a collective construction. All community participation strengthens health interventions. This is essential in crisis contexts to fight for violated rights.

The aim of this paper is to account for the modalities in which Malvinas veterans' health was constituted as a problem requiring state intervention between 1984 and 2000. In order to do so, we have focused on the concept of problematization as a way to analyze practices and political thought. The text consists of three sections: the first one presents the methodological basis of the analysis of public policies, whereas the second and third ones intend to analyze a series of laws, bills, decrees, reports and other documents produced by different state spheres about war veterans and their health situation. The hypothesis that we propose is that the Malvinas veterans were problematized as a marginal segment of the population, although the stabilization of a specific treatment took more than fifteen years to materialize.

This paper analyze multiple experiences about the functioning of the first Open-Door in Argentina's inside, the "Asilo Colonia Regional Mixto de Alienados Oliva", created in the province of Cordoba in 1914. We approach a set of clinical histories and specialized publications of the institutional bulletin, deepening in theoretical and therapeutic processes articulated during the first decade of hospitalization of a patient who lived in Oliva most of her adult life. This study case questions the relevance given to this madhouse as a space of reclusion and social control. We show that, in a context of crisis about institutional resources and transformation into psychiatric models, the configuration of know-what and know-how of these alienists did not constitute a monolithic authority, accounting for how the behaviors of patients and their relatives, values and social uses defined types of income, diagnoses and treatment possibilities.

This paper intends to analyze the professional intervention in devices that work with young people inserted in the Juvenile Criminal Responsibility System, in the province of Buenos Aires, Argentina, denaturing the punitive view of the problem of psychoactive substance use. The proposed analysis is based on understanding the consumption as a problem of health and from current regulations to seek to problematize the punitive response, to account for the different levels of consumption and to denaturalize the stigmatizing relationship between crime and problematic consumption.

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.

In this paper we report the findings of the first "Epidemiological study of mental health in the general population of Argentina" in the framework of the World Mental Health Survey Initiative WHO / Harvard, in collaboration with the Faculty of Medicine of the University of Buenos Aires and the Asociación de Psiquiatras Argentinos (APSA) with funding from the Ministry of Health. Methodology: A multistage probabilistic household survey was conducted using the Composite International Diagnostic Interview (CIDI). The survey was conducted on 3,927 people aged 18 and over (no age limit), with fixed residence in one of the eight largest urban areas in the country (Buenos Aires, Córdoba, Corrientes-Resistencia, Mendoza, Neuquén, Rosario, Salta and Tucumán), representing approximately 50.1% of the adults living in the country. The response rate was 77%. Results: The lifetime prevalence of any mental disorder in the general population of Argentina over 18 years of age was 29.1% and the projected life risk up to 75 years of age was 37.1%. The disorders with the highest life prevalence were Major Depressive Disorder (8.7%), Alcohol Abuse Disorder (8.1%) and Specific Phobia (6.8%). Anxiety Disorders were the most prevalent group (16.4%), followed by Mood Disorders (12.3%), Substance Disorders (10.4%), and Impulse Control Disorders (2.5%). The prevalence in the last 12 months of any mental disorder was 14.8%, a quarter of wich were classified as severe. 11.6% received treatment in the previous 12 months and only 30.2% of those who suffered a severe disorder received it. The results provide essential data for health planning and implementation and the training of the mental health workforce.

In the context of social and demographic studies of sexual and reproductive health, this paper discusses the situation of young people in Argentina, emphasizing the problems revolving around Sexually Transmitted Diseases (STDs) and the compliance with sexual rights. This work aims to study the calendars and characteristics of the onset of sexual life in young Argentinean people and to describe the current situation of knowledge, practices, and access related to sexual life. Based on data from the National Survey on Sexual and Reproductive Health ( 2013) we worked with the universe of young people between 15 and 29 years of age (n = 2,084 women, n = 1,872 men, without weighting) and analyzed the differences in the calendars of the onset of sexual life, as well as the knowledge and prevention of STDs by gender sex, age groups, household income and geographical regions.A national scenario was found featuring marked tendencies in the calendars of first sexual intercourse by gender sex, as well as in the knowledge about STDs. However, the analysis by region and household income in each gendersex showed high heterogeneities, which would indicate certain limitations in the access to sexual education and the effective compliance of people's rights, as well as an increased risk to contracting STDs in specific social groups.

In this paper, we present the results of a survey that was part of a regional project on smokable cocaine substance developed in Argentina, Brazil, Chile, Paraguay and Uruguay. We analyze the characteristics of users of smoked cocaine who attend treatment centers or institutions in Buenos Aires (Argentina) that provide support and care, but not a formal treatment for drug abuse. We analyze their sociodemographic characteristics, their social supports, their health, their drug use patterns (age of onset, substances, use frequency and procedures of administration) and their history of treatment. The methodological strategy was quantitative. Through a non-probability sampling, we developed a survey study with 148 cases. Among the main results, we found that this population faces vulnerability processes in multiple spheres: work, education, housing, health and social links.

The changes initiated by the new National Civil and Commercial Code in Argentina underline the pediatric task to empower children's and adolescents' developing autonomy. In this paper, we have framed a model describing autonomy in child healthcare. We carried out a literature review focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of competent decisionmaking development. We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatricianchild relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of autonomy, based on the level of respect of the child's moral equality. Contextual, existential, conceptual, and socialethical conditions shall be considered when applying the model to facilitate dialogue between pediatricians, children, parents and other actors., (Sociedad Argentina de Pediatría.)

Kleine-Levin syndrome is an uncommon disorder with recurrent episodes of hypersomnia, and behavioral abnormalities such as binge-eating and hypersexuality. Our aims were to report cases of the Kleine-Levin syndrome diagnosed in Buenos Aires, Argentina and to characterize the clinical presentation of these patients. We evaluated patients with Kleine-Levin syndrome according to the International Classification of Sleep Disorders. Psychiatric, physical and neurological symptoms were present. Some patients were investigated with brain Magnetic Resonance Imaging, Single Photon Emission Computed Tomography, electroencephalogram and some with polysomnography. Seven patients (2 female, 5 male), ages from 8 to 47 years (median 20.7 years) were included in the study. The duration of symptoms was 1.5-20 days with a mean of 8. The range of interval between episodes: 2.5-24 months, median=13. All seven patients had a history of hypersomnia (one of them post head injury); 5 reported hyperphagia and 2 reduced appetite. Brain MRI was performed in 6 patients: 1 showed non-specific abnormalities and another presented diencephalic hematoma; the rest were normal. Our paper is the first one in Buenos Aires reporting Kleine-Levin syndrome of different ethiologies. The prevalence is difficult to estimate in our country.

Taking into account the discontinuity between the body and the soul as a manifestation of the dominant "great division" of modernity, this paper intends to reflect critically on the scope of this division in the analysis of the therapeutic dimension of New Age style spirituality. Through participant observation, open-ended interviews and shared experiences with members of a spiritual movement of Indian origin, The Art of Living, carried out between 2012 and 2017 in Buenos Aires, Argentina, we describe two processes. First, the institutional discourse of the movement and its location within public disputes regarding the tension between the therapeutic and the religious. Second, we analyze regimens of everyday relationships that produce multiple agencies and a spiritual grammar. We then suggest the importance of attending to a relational and assembled framework that challenges the more conventional dualism between the therapeutic/religious in the light of a more general contemporary process of ordinarization in the management of well-being.

With the appearance of biological treatments, therapeutics has changed in many rheumatological, dermatological and oncological diseases. Due to the high cost of these biological medicaments and the expiration of patents, the pharmacological industry develops biosimilars, drugs that are a version (copy) of the substance of the original biological medicine, with the aim of facilitating access to these treatments. These biosimilars are prepared according to the specific requirements of regulatory bodies in terms of quality, efficacy and safety, and must be shown they are comparable to the reference product. This paper reviews the international and national regulatory framework, the controversies surrounding biosimilars, and presents the position of a group of experts regarding the use of biosimilars.

Introduction: One of the factors identified to reduce medical errors has been the organisational culture. Education is proposed as a tool for its modification, but this does not have a unique way of being achieved. This paper sought to describe a patient safety elective for medical students and to determine their perceptions on the subject., Materials and Methods: A descriptive study was performed in the Center of Medical Education and Clinical Investigations, in Argentina. Every student who participated in the elective was included, and there were no exclusion criteria. An online survey was conducted on all participants, and individual interviews were conducted on a convenience sample., Results: The subject was chosen by 54 students out of a total of 274 students between 2011 and 2014. All (100%) of the students completed the course and passed the exam, and stated that they would recommend the elective. Most of the students (n=26) agreed that patient safety content should be mandatory, that its content was novel, and that the subject's structure seemed appropriate, with 21 saying that it was the first time they had been talked about these issues. From the individual interviews, students emphasised the novelty of the subject, and that their perception on patient safety issues had increased., Discussion: The proposed elective had a good reception among students. The methodology planned for its teaching seemed appropriate. Inter-professional education in patient safety should be implemented to improve student competencies in the subject., (Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Drinking water monitoring plans are important to characterize both treated and untreated water used for drinking purposes. Access to drinking water increased in recent years as a response to the Millennium Development Goals set for 2015. The new Sustainable Development Goals aim to ensure universal access to safe drinking water by 2030. Within the framework of these global goals, it is crucial to monitor local drinking water systems. In this paper, treated and untreated water from different sources currently consumed in a specific town in Salta, northern Argentina, was thoroughly assessed. Monitoring extended along several seasons and included the physical, chemical and microbiological variables recommended by the Argentine Food Code. On the one hand, treated water mostly complies with these standards, with some non-compliances detected during the rainy season. Untreated water, on the other hand, never meets microbiological standards and is unfit for human consumption. Monitoring seems essential to detect anomalies and help guarantee a constant provision of safe drinking water. New treatment plants are urgently needed to expand the water grid to the entire population., (Copyright © 2017 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.)

This paper presents the results of an ethnographic study of an obstetric center within a hospital of Greater Buenos Aires and an analysis of the spatio-temporal dimension of hospital care. The fieldwork, carried out between 2007 and 2011, followed the everyday dynamics of the hospital and included observation in the obstetrics unit (waiting areas, the obstetric center where births and emergencies receive care, and the ambulatory care, ultrasound, and hospitalization rooms, among others) as well as spaces such as the appointments and statistics offices, the office of social services, the central hall, the pharmacy, and hallway waiting areas. Interviews were carried out with department heads, obstetricians, nurses, social workers, staff of the laboratory and the appointment and statistics offices, volunteers and patients. In this way, the article analyzes the medical-bureaucratic routines in the admission and hospitalization of women in the obstetrics center; the disputes, transactions and negotiations occurring among professionals, patients and families; the delimitation of spaces; and the temporal sequences and hierarchies involved in the passage from the "outside" to the "inside" of the hospital.

Introduction: Whooping cough is a re-emerging infection in the world and Latin America., Objective: It was considered relevant to investigate the clinical and epidemiological profile of Bordetella spp. and Bordetella pertussis infection in Córdoba province, Argentina; evaluating, at the same time, the co-infection with virus producing respiratory infections that may be confused with whooping cough., Material and Methods: All whooping cough suspected cases were studied by Polimerase Chain Reaction, amplifying the repeated insertion sequence (IS) 481 and the promoter gene encoding pertussis toxin, between 2011 and 2013. The data were obtained from the clinical and epidemiological records., Results: From 2,588 whooping cough suspected cases, 11.59% was infected by Bordetella spp. and 9.16% was confirmed as Bordetella pertussis infection. The rate of infection was 7.22 and 1.84 per 100,000 for 2011 and 2012, respectively. The infection presented a seasonal tendency and it was mainly found on the group of children between 13 and 24 months old. The co-infection with virus producing respiratory infections, were uncommon. Paroxysmal cough, cyanosis and/or vomiting were predictors of the infection for Bordetella pertussis., Discussion and Conclusions: To deal with the re-emergence of whooping cough is important the knowledge of the regional epidemiological situation. This paper shows the situation of these infections in the regional clinical and epidemiological context, and makes the information available for health decision-making.

The collection of fungal pathogens and symbionts of insects and other arthropods of the Centro de Estudios Parasitológicos y de Vectores, La Plata, Argentina, is unique because it preserves in vivo and in vitro cultures of fungal pathogens. This culture collection is open for research, teaching, consulting services, and strain deposit. It contains 421 strains belonging to 23 genera (16 Ascomycota, 4 Entomophthoromycotina, 2 Glomeromycota and 1 Oomycota), and the cultures are preserved by different methods such as cryopreservation in freezer at -20°C and -70°C, paper, distilled water and lyophilization. Fungi were isolated from insects, other arthropods, and soil (by using insect baits and selective media). Species were identified by morphological features and in a few strains by molecular taxonomy (PCR of rDNA). This collection is a reference center for species identification/certifications, research and teaching purposes, strain deposit, transference and consultancy services, and its overall goal is to preserve the fungal germplasm and ex situ diversity. Most of the strains are native of Argentina. The collection was originated in 1988 and is registered in the Latin American Federation for Culture Collections and in the World Federation of Culture Collections., (Copyright © 2016 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Dengue outbreaks have occurred yearly in Argentina since 1998. A number of candidate vaccines have been tested in endemic countries. The most advanced one was licensed in three countries of Latin America for children over 9 years of age. In the present article the benefits and drawbacks of these vaccines as well as the challenges for the implementation of a vaccination strategy in Argentina are discussed. Furthermore, a risk stratification strategy with new criteria and a multidisciplinary vision is suggested as a possible path for the assessment of the pertinence of a vaccination program in areas showing the highest risk of dengue transmission and/or for people at the greatest risk of developing severe dengue. It is also suggested that the definition regarding the status of endemicity should take into account the local realities. Finally, this paper proposes a broad discussion on the evidences, the expected impact and instrumental aspects that would be involved in the incorporation of a dengue vaccine, marketed or in development, into the national immunization program, and especially which subpopulation should be targeted for the immunization strategy to be cost-effective.

Research is a cornerstone in the training of medical doctors in any specialty, whereas it substantially contributes to good clinical practice. The aim of this study is to determine the importance of research among psychiatrists in training in Ciudad de Buenos Aires. A cross sectional descriptive study using a paper survey, which was voluntary and anonymous, was sent to psychiatrists in training in different training centers between October-November 2013. 76.6% considered research training deficient; 27.8% participated in a research project during their psychiatric training and only 21.5% presented their results at a scientific activity. 95.6% participants considered important to include research in their training. In summary, a small proportion of psychiatrists in training who participated in this study conducted research and we observed limited experience in the area, as opposed to the interest in being trained in this field.

Approximately 12,000 individuals are treated with clozapine per year in Argentina. The use of this antipsychotic is associated with the occurrence of various side effects; the most serious of these is agranulocytosis, which can be fatal but reversible if detected early. For this reason, clozapine is under a pharmacovigilance intensive program centered by the National Administration of Drugs, Foods and Medical Devices. The present paper reviewed the current legislation for the use of clozapine in Argentina and compared the data obtained from the pharmacovigilance system with those reported in other countries. Further, difficulties that may arise during the reexposure of patients to clozapine are discussed.

Recommendations for Hepatitis C screening based on risk factorsfor transmission proved to be ineffcient. Accordingly, the CDC recommended to screen all American individuals born between 1945-1965, based on data from population prevalence of infection. The effectiveness of implementing these recommendations in other contexts and/or populations can be estimated, in principle, knowing the age distribution of infected individuals. There is no data on population prevalence in our country. Yet we can know the age distribution of cases of Hepatitis C who accessed the health system. The aim of this paper is to analyze the distribution by birth cohort ofcases registered as "Hepatitis C" in the Sentinel Units for Viral Hepatitis in the 2007-2014 period. This will contribute to the identification, if any, ofa cohort in which case the recommendation of screening could be addressed, based on risk factors inherent to our country and our epidemiological reality. The age distribution of our cases was wider and younger than those of the population supporting the recommendation of the CDC and this suggests -beyond the difference in the populations being compared- is due to a range of risk factors and age at different infection between USA and Argentina. Thus, based on these results, the recommendation of the Argentine Consensus for Hepatitis C in 2013 to screen all individuals once in life is supported.

The aim of this paper is to describe the epidemiological characteristics, clinical management and pathologic patterns in a population with renal tumors in our institution. Prospective data collection was performed over a period of 4.5 years, from January 2010 to June 2014. A total of 819 cases (796 patients) were treated for renal mass during this period. The mean age was 60.7 years (SD 13.1). There were 553 (69.5%) males (male to female ratio: 2.2: 1). Twenty nine per cent (230 patients) were obese (BMI = 30). The diagnosis was incidental in 653 cases (79.7%), 48.8% presented one or more risk factors, being smoking the most frequent (34%). In 238 patients (29.9%) there was more than one comorbidity; 18% had preoperative creatinine = 1.3 mg/dl. Lesions were = 4 cm (cT1a) in 45% of the patients, and 10.8% (86) had metastases at diagnosis. The lesions were resected in 93.5% and actively monitored in 6.5% (not resected). In surgery treated patients, radical nephrectomy was performed in 51.5% of cases, and nephron sparing surgery in 48.5% of them. The laparoscopic approach was used in 56.2%. The pattern of presentation of renal masses is characterized by incidental diagnosis in early disease stages. Nephron sparing surgery is the first choice in nearly half of patients. Active surveillance has been used in a greater percentage than previously reported.

This paper analyzes problems experienced by policy-holders of voluntary private health insurance plans in Argentina when insurance companies fail to comply with the Consumer Protection Code. The sample consisted of consumer complaints filed with the Consumer Protection Bureau and rulings by the Bureau from 2000 to 2008. One striking issue was recurrent non-compliance with services included in the Mandatory Medical Program and the companies' attempts to blame policy-holders. According to the study, the lack of an information system hinders scientific studies to adequately address the problem. Thus, a comparison with studies on health insurance in other Latin American countries highlighted the importance of such research, the relationship to health systems, constraints on use and denial of citizens' rights to healthcare, and the increasing judicialization of healthcare provision.

This interdisciplinary paper summarizes the news in the diagnosis and treatment of chronic urticaria (CU), and provides concepts, definitions and evidence-based suggestions for its management. Urticaria occurs in at least 20% of the population at some point in their lives. Acute urticaria (less than 6 weeks' duration), differs from CU in its etiology, but the onset of this disease is always acute. CU may occur as spontaneous (SCU) or induced (ICU). The diagnosis is simple, although a careful evaluation is necessary for differential diagnosis. ICU's diagnosis is mainly clinical, even if provocation tests can be useful. Supplementary studies should be limited and based on the clinical suspicion. Treatment may be divided into three approaches: avoidance, elimination or treatment of the cause, and pharmacological treatment. Recently treatment has been modified with the use of second-generation antihistamines as first-line and increased doses of nonsedating H1 antihistamines, up to 4 times, as second line. Antihistamines are essential to treat CU; however, 40% of patients do not achieve good control despite increased doses and require additional treatment. The most recent evidence indicates a group of drugs to be used as third line in these cases, to improve quality of life and to limit toxicity from frequent or chronic use of systemic steroids. Only 3 drugs are recommended as third line: omalizumab, cyclosporin A or anti-leukotrienes.