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Purpose: Rituximab [chimeric anti-CD20 monoclonal antibody], alone or combined with chemotherapy, is used in the treatment of non–Hodgkin's lymphoma (NHL). Rituximab binds to CD20 and inhibits intracellular survival/growth pathways leading to chemo/immunosensitization of tumor cells in vitro. The contribution of rituximab Fc-FcR interaction in signaling is not known. This study examined the role of Fc-FcR interactions in rituximab-induced signaling using rituximab (Fab')2 fragments as well as rituximab devoid of the CH2 Fc-binding domain (CH2−).Experimental Design: Rituximab (CH2−) and rituximab (Fab')2 were tested for their activity on B-NHL cell lines. Cell signaling and sensitization to chemotherapy and immunotherapy were examined. The in vitro studies were validated in mice bearing tumor xenografts.Results: Although the modified antibodies were defective in antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity functions, they retained all other biological activities such as inhibition of cell proliferation, induction of cell aggregation, and apoptosis induction. In addition, similar to rituximab, the modified antibodies inhibited the activity of cell survival/growth pathways and their associated transcription factors (e.g., NF-κB, YY1, SP-1), and signal transducers and activators of transcription 3 (STAT-3), and downregulated the expression of antiapoptotic gene products, such as Bcl-2/Bclxl, which regulate drug resistance. The modified antibodies, similar to rituximab, sensitized resistant B-NHL cells to both CDDP and Fas ligand–induced apoptosis. Furthermore, treatment of nude mice bearing Raji tumor cell xenografts with the combination of rituximab (Fab')2 or rituximab and CDDP resulted in similar and significant inhibition of tumor growth.Conclusion: These findings reveal that rituximab-mediated inhibition of intracellular signaling pathways and leading to chemo/immuno-sensitization of resistant B-NHL is Fc independent. (Clin Cancer Res 2009;15(21):6582–94)

Supplementary Data from Rituximab-Mediated Cell Signaling and Chemo/Immuno-sensitization of Drug-Resistant B-NHL Is Independent of Its Fc Functions

Population’s aging and the increased number of Chronic Complex Patients (CCP) in unprepared environments for this complexity among a fragmented system which has a high variability and that is centered in chronic diseases acute failure and the lack of planning in the different levels of attention, may benefit hospital readmission which is expensive and unnecessary, avoidable adverse events and mistakes related with drugs, which may diminish the patient’s level of satisfaction. This presents a scenario that poses important challenges for the health system organization and for the provision of services to improve the quality of the assistance, the patient’s satisfaction and to diminish expenses.All of these factors create the need of designing patient oriented care plans.At HIBA (Hospital Italiano de Buenos Aires), we have an integrated attention program for CCP with a Home Care focus. We follow a Home Based Primary Care Model locally defined as Home Care. The 80% of admissions from a hospitalization to Home Care Medicine are of CCP. There is a complexity due to the clinical approach and the potential intensive use of resources.The transition process has not been standardize among the different areas according to the complexity of CCP in Home Care. Nevertheless, in the clinical hospitalization area, many groups worked with different integration levels to approach these type of patients, working with episodic nonintegrated care plans.We presented this problem and the proposal was to create an interdisciplinary work team. This team was composed by the different areas involved in the attention of these CCP candidates who were to be admitted in Home care (Geriatrics, Medical Clinic, Social Services, Rehab, Pharmacy, Nursing, Home Care, Health Plan Management, Dismissal Planning Unit, Palliative Care, and Medical Informatics) to improve care’s continuity through a shared and customized care plan. The priority was to organize care goals according to the patient’s needs by using a common language and precise tools. We ranked the population and decided to intervene the group with higher risk (Chronical Complex Patients). The different involved areas decided on the assistance process for the CCP: they defined roles and a set of steps to implement in each area oriented to improve the hospital-home transition in a way that benefits safety, quality of assistance, the patient’s satisfaction and his environment and the health team.After 3 months of training, we initiated the implementation increasingly and evaluated the process indicators quarterly with the goal of assessing adhesion and the proposal’s feasibility. We reached more than a 60% in most of the interventions.The path we have been through allows us to confirm that planning the patient centered transition of CCPs to Home Care benefits the comprehensive interdisciplinary care through a common language. It also enhances the patient’s satisfaction and his environment by preparing the caregiver for the CCP’s management at home care. It makes effective communication easier among the different attention areas and it provides the possibility to create a unique shared and customized plan for the CCP by benefiting continued assistance.

A program for the hematologic patient at very high risk of infections (HAR, from its initials in Spanish) was implemented, based on a multidisciplinary team and six measures intended to reduce the colonization and subsequent sepsis by multidrug-resistant organisms (MDRO). We aimed at evaluating the effectiveness of the HAR program in terms of MDRO infections mainly caused by Klebsiella pneumoniae carbapenemase-producing and multidrug-resistant Pseudomona aeruginosa, and sepsis-related mortality. We established retrospective comparisons between the pre-HAR period (2016–2018) and the post-HAR period (2018–2019), in patients who received a hematopoietic stem cell transplant (HSCT) and/or intensive chemotherapy to treat non-M3 acute myeloid leukemia (CH-AML). We included 262 patients: 176 pre-HAR and 86 post-HAR. MDRO infection was 4.6% at 30 days and 6.1% at 90 days (all the cases during the pre-HAR period). Sepsis-related mortality was 6.5%, considering a median follow-up of 608 days: 6.1% in the HSCT group and 12.4% in the CH-AML group (p = 0.306). Sepsis-related mortality was 8.7% in the pre-HAR period and 0% in the post-HAR period (p = 0.014). The implementation of this multidisciplinary program based in preventive measures and the appropriate use of antibiotics enabled a decrease in sepsis-related mortality in very high-risk hematologic patients.

IntroductionOlder adults with advanced chronic diseases require an integrated model of care that includes an adaptation of the therapeutic effort. The objective of this work was to estimate compliance with a standardized process of identification and registry of advance care planning (ACP) of patients in chronic home care (CHC) with palliative needs living in nursing homes and referred to the Hospital for COVID19.Theory/MethodsProspective cohort of patients in nursing home chronic care, >64 years, affiliated to the Health Maintenance Organization Hospital Italiano de Buenos Aires, with a diagnosis of COVID19 infection (3/15/2020 to 9/15/2020). The standardized care process uses the identification of patients with palliative needs based on the Necpal tool and registry of the advanced care planning in a central place in the electronic health record (EHR).Results30% (1032) of CHC patients live in nursing homes. 65% (374/568) of suspected cases for COVID-19 were confirmed as positive.Among COVID-19 cases: 88% were women, median age was 88 yo., 92% were admitted to the Hospital, 0.3% used invasive ventilation, 80% (295) were stratified and identified in the EHR as patients with palliative needs, 68% (199) had the ACP registered in the EHR. 32.6% of hospitalized patients met severity criteria. 1% of patients with advanced chronic diseases with severity criteria were admitted to the intensive care unit. Mortality was 25% (94/374). Of those who died, 74.4% had severity criteria (p

Adverse drug reactions are a common cause of potentially avoidable harm, particularly in older adults. To evaluate the feasibility and efficacy of a pilot multifactorial intervention to reduce potentially inappropriate medication (PIM) use in older adults. We conducted a phase 2, feasibility, open-label study in the ambulatory setting of an integrated healthcare network in Buenos Aires, Argentina. We recruited primary care physicians (PCPs) and measured PIM use in a sample of their patients (65 years or older). Educational workshops for PCPs were organized with the involvement of clinician champions. Practical deprescribing algorithms were designed based on Beers criteria. Automatic email alerts based on specific PIMs recorded in each patient’s electronic health record were used as a reminder tool. PCPs were responsible for deprescribing decisions. We randomly sampled 879 patients taking PIMs from eight of the most commonly used drug classes at our institution and compared basal (6 months prior to the intervention) and final (12 months after) prevalence of PIM use using a test of proportions. There was a significant reduction (p

To explore perceptions, concerns and needs of healthcare professionals in an emergency department (ED) from Argentina.Participatory action research, coordinated and carried out by ED healthcare professionals, which included physicians, nurses and administrative staff who actively engaged in both data collection and analysis. Mixed methodologies were used: documentary analysis of complaints and written claims by patients, 10 individual interviews, and two reflective focus groups of 10 healthcare professionals (who differed in occupation, seniority and experience, including residents in training).The topics that emerged were work factors that lead to errors and threaten patient-centered clinical encounters: work overload and lack of time, the overuse of resources for defensive medicine purposes and technology that replaces physical contact. Healthcare professionals reported episodes of aggression by patients or their families, when long waits and structural insufficiencies (such as lack of beds, saturation of the waiting room, discomfort) threaten patience and tolerance. From these insights, improvements were generated in various areas of the ED.The identification of problems by the ED stakeholders l was a relevant approach that led to a process of collective management change, promoted reflection and raised awareness, allowing the identification of areas for improvement, design strategies and concrete feasible proposals.Explorar las percepciones, preocupaciones y necesidades del personal de salud en una Central de Emergencias de Adultos (CEA) de Argentina. Métodos: Investigación o acción participativa, coordinada y ejecutada por el propio personal de la CEA, que incluyó médicos/as, personal de enfermería y administrativo/as para participar activamente en la recolección de información y en el análisis. Se utilizaron metodologías mixtas: análisis documental de quejas y reclamaciones escritas por parte de los pacientes, 10 entrevistas individuales y 2 grupos focales reflexivos con 10 integrantes del personal de salud (de diferente cargo y antigüedad, y residentes en formación).Los tópicos emergentes fueron factores laborales que inducen al error y atentan contra el encuentro clínico centrado en la persona: la sobrecarga y la falta de tiempo, la sobreutilización de recursos por medicina defensiva y la tecnología que reemplaza el contacto físico. El personal de salud manifestó episodios de agresiones de pacientes o sus familiares, cuando las largas esperas y las insuficiencias estructurales (como falta de camas, saturación de sala de espera, incomodidad) atentan contra la paciencia y la tolerancia. A partir de esta reflexión se generaron mejoras en diversas áreas de la CEA.La identificación de las problemáticas realizadas por los propios actores de la CEA resultó un método pertinente para generar un proceso de cambio de gestión colectiva, promover la reflexión y concientizar, permitir identificar áreas de mejora, diseñar estrategias y propuestas concretas.

Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until EDreadmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31- 3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety. Introducción: Describir las características de los pacientes COVID-19 con síntomas leves dados de alta desde la Central de Emergencias de Adultos (CEA) y seguidos en forma ambulatoria mediante telemedicina. Estimar las tasas de re-consulta a CEA y hospitalización, y explorar los factores asociados a estos desenlaces. Métodos: Cohorte retrospectiva de Junio a Agosto 2020 en el Hospital Italiano de Buenos Aires, que incluyó personas COVID-19 con síntomas leves. Se siguieron durante 14 días hasta la ocurrencia de re-consulta en CEA y/o hospitalización. Se utilizaron modelos de Kaplan-Meier y regresión logística. Resultados: De un total de 1.239 pacientes, con una mediana de 41 años y 53,82% varones, 167 pacientes reconsultaron a CEA, con una tasa de incidencia global a los 14 días del 13,08% (IC del 95% 11,32 a 15,08). De estos, 83 requirieron hospitalización (media de 4,98 días), el 6% no se relaciona con COVID-19 y 5 pacientes fallecieron. Después del ajuste por factores confundidores (edad ≥65, sexo, diabetes, hipertensión, ex tabaquismo, tabaquismo activo, fiebre, diarrea y saturación de oxígeno), encontramos asociaciones significativas: tabaquismo anterior (ORa 2,09, IC95% 1,31-3,34, p0=0,002), fiebre (ORa 1,56, IC95% 1,07-2,28, p=0,002) y saturación de oxígeno (ORa 0,82, IC95% 0,71-0,95, p=0,009). Conclusión: La tasa del 13% de re-consulta a CEA durante 14 días de seguimiento resultó muy significativa para la gestión hospitalaria, la calidad del desempeño y la seguridad del paciente. Introdução: Descrever as características dos pacientes com COVID-19 com sintomas leves e alta do Centro de Emergência de Adultos (CEA) e acompanhados ambulatorialmente por telemedicina. Estime as taxas de nova consulta ao CEA e de hospitalização e explore os fatores associados a esses resultados. Métodos: Coorte retrospectiva de junho a agosto de 2020 no Hospital Italiano de Buenos Aires, que incluiu COVID-19 com sintomas leves. Eles foram acompanhados por 14 dias até a ocorrência de nova consulta no CEA e / ou internação. Modelos de Kaplan-Meier e regressão logística foram usados. Resultados: De um total de 1.239 pacientes, com mediana de 41 anos e 53,82% homens, 167 pacientes consultaram novamente o CEA, com uma taxa de incidência global em 14 dias de 13,08% (IC95% 11,32 a 15,08). Destes, 83 necessitaram de hospitalização (média de 4,98 dias), 6% não estavam relacionados com COVID-19 e 5 pacientes morreram. Após o ajuste para fatores de confusão (idade ≥65, sexo, diabetes, hipertensão, ex-tabagismo, tabagismo ativo, febre, diarreia e saturação de oxigênio), encontramos associações significativas: tabagismo prévio (ORa 2,09, IC 95% 1,31-3,34, p0 = 0,002), febre (ORa 1,56, IC 95% 1,07-2,28, p = 0,002) e saturação de oxigênio (ORa 0,82, IC 95% 0,71-0,95, p = 0,009). Conclusão: A taxa de 13% de re-consulta ao CEA durante 14 dias de seguimento foi muito significativa para a gestão hospitalar, qualidade do desempenho e segurança do paciente. Fil: Pedretti, Ana. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Márquez Fosser, Santiago. McGill University; Canadá. Hospital Italiano; Argentina Fil: Pasquinelli, Rosario. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Vallone, Marcelo. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Plazzotta, Fernando. Hospital Italiano; Argentina Fil: Luna, Daniel Roberto. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; Argentina Fil: Martínez, Bernardo. Hospital Italiano. Departamento de Medicina.; Argentina Fil: Rodriguez, Paz. Hospital Italiano; Argentina Fil: Grande Ratti, María Florencia. Hospital Italiano; Argentina

In this paper, we addressed the problem of controlling the position of a group of unicycle-type robots to follow in formation a time-varying reference avoiding obstacles when needed. We propose a kinematic control scheme that, unlike existing methods, is able to simultaneously solve the both tasks involved in the problem, effectively combining control laws devoted to achieve formation tracking and obstacle avoidance. The main contributions of the paper are twofold: first, the advantages of the proposed approach are not all integrated in existing schemes, ours is fully distributed since the formulation is based on consensus including the leader as part of the formation, scalable for a large number of robots, generic to define a desired formation, and it does not require a global coordinate system or a map of the environment. Second, to the authors’ knowledge, it is the first time that a distributed formation tracking control is combined with obstacle avoidance to solve both tasks simultaneously using a hierarchical scheme, thus guaranteeing continuous robots velocities in spite of activation/deactivation of the obstacle avoidance task, and stability is proven even in the transition of tasks. The effectiveness of the approach is shown through simulations and experiments with real robots.

Fast autonomous motion in cluttered and unknown environments, such as forests, is highly dependent on low-latency obstacle avoidance strategies. In this context, this paper presents a motion planning strategy that relies on lattices for the fast computation of local paths that both avoid obstacles and follow a vector field that encodes the global robot task. Lattices are constructed in the sensor space and represent a set of search trees that can be quickly pruned in function of the detected obstacles. The remaining lattice trees are used to optimize a vector field-dependent functional, thus generating the best free local path that tracks the field. To illustrate the proposed approach, we present simulation and real-world experiments of a planar robot moving in a cluttered, forest-like environment.

Background. Sedum dendroideum has antioxidant effects that are beneficial for different diseases. We aimed to analyze the antiproliferative activity of S. dendroideum in human pterygium fibroblasts (HPFs). Methods. HPFs were treated for 24 h with 0–1000 μg/mL of S. dendroideum lyophilized to analyze its effect on cell viability using the CellTiter assay. RNA from HPF treated with 250 μg/mL of S. dendroideum lyophilized was isolated, and the expression of VEGF and CTGF genes was evaluated by qPCR. A dermal fibroblast cell line (HDFa) was used as a healthy control. The total phenolic content, antioxidant activity, and chemical profile of S. dendroideum lyophilized were determined. Results. Viability of HPF decreased after 24 h treatment of S. dendroideum in a dose-dependent manner. The expression of VEGF and CTGF significantly decreased ( P < 0.01 ) in HPF treated with 250 μg/mL of S. dendroideum when compared with untreated HPF. The total phenolic concentration in the S. dendroideum lyophilized was 33.67 mg gallic acid equivalents (GAE)/g. Antioxidant activity was 384.49 mM Trolox equivalents/mL. The main phenolic compounds identified by HPLC analysis were the kaempferol-3-O-glycoside, kaempferol-3-O-rhamnoside, kaempferol-3-O-neohesperidoside-7-O-α-rhamnopyranoside, and kaempferol-3-O-glycoside-7-O-rhamnoside. Conclusions. S. dendroideum decreases the proliferation of HPF and the expression of VEGF and CTGF. The phenolic compound concentration, antioxidant activity, and phytochemical profile may play a role in these effects.

Background SARS-CoV-2 is a novel coronavirus described for the first time in China in December 2019. This virus can cause a disease that ranges in spectrum from asymptomatic to severe respiratory disease with multiorgan failure, and the most severe cases are associated with some comorbidities and patient age. However, there are patients who do not have those risk factors who still develop serious disease. Methods In this study, we identified the presence of other respiratory viruses in positive cases of COVID-19 in Mexico to determine if any coinfections were correlated with more severe manifestations of COVID-19. We analysed 103 confirmed cases of COVID-19 using RT-qPCR for the detection of 16 other respiratory viruses. Results Of the cases analysed, 14 (13.6%) were cases of coinfection, and 92% of them never required hospitalization, even when comorbidities and advanced age were involved. There weren’t significant differences between the presence of comorbidities and the mean ages of the groups Conclusions These results suggest that coinfection is not related to more severe COVID-19 and that, depending on the virus involved, it could even lead to a better prognosis. We believe that our findings may lay the groundwork for new studies aimed at determining the biological mechanism by which this phenomenon occurs and for proposing corresponding strategies to limit the progression to severe cases of COVID-19.

Highlights • The scope in the SDGs spanning functions such health-system access and quality care. • Low-cost quality indicators represent an initiative to improve health outcomes. • We evaluate the rate of ED-visits and hospital readmission rate after discharge. • Improvement efforts to reduce these indicators are necessary. • Strategies to detect causes and avoid potentially preventable factors will be needed., Background and goal of study The scope of health in the Sustainable Development Goals is much broader than the Millennium Development Goals, spanning functions such as health-system access and quality of care. Hospital readmission rate and ED-visits within 30 days from discharge are considered low-cost quality indicators. This work assesses an indicator of quality of care in a tertiary referral hospital in Argentina, using data available from clinical records. Purpose To estimate the rate of ED-visits and the hospital readmission rate (HRR) after a first hospitalization (First-H), and to identify associated factors. Methods This retrospective cohort included patients who had a First-H in Hospital Italiano de Buenos Aires between 2014-2015. Follow-up occurred from discharge until ED-visit, readmission, death, disaffiliation from health insurance, or 13 months. We present HRR at 30 days and ED-visits rate at 72 hours, using the Cox proportional-hazards regression model to explore associated factors, and reporting adjusted hazard ratios (HR) with their respective 95%CI. Results The study comprised 10,598 hospitalizations (median age was 68 years). Of these, 5,966 had at least one consultation to the ED during follow up, resulting in a 24 hour rate of consultations to ED of 1.51% (95%CI 1.29-1.72); at 48 hours 3.18% (95%CI 2.86-3.54); at 72 hours 4.71% (95%CI 4.32-5.13). In multivariable models, factors associated for 72 hours ED-visits were: age (aHR 1.06), male (aHR 1.14), Charlson Comorbidity Index (aHR 1.16), unscheduled hospitalization (aHR 1.39), prior consultation with the ED (aHR 1.08) and long hospital stay (aHR 1.39). Meanwhile, 2,345 patients had at least one hospital readmission (98% unscheduled), resulting a 24 hour rate of 0.5% (95%CI 0.42-0.71), at 48 hours 0.98% (95%CI 0.80-1.18), at 72 hours 1.4% (95%CI 1.2-1.6); at 30 days 7.7% (95%CI 7.2-8.2); at 90 days 13% (95%CI 12.4-13.8); and one-year 22.5% (95%CI 21.7-23.4). Associated factors for HRR at 30 days were: age (HR 1.16), male (HR 1.09), Charlson comorbidities score (HR 1.27), social service requirement during First-H (HR 1.37), unscheduled First-H (HR 1.16), previous ED-visits (HR 1.03) and length of stay (HR 1.08). Conclusion Priorities efforts to improve must include greater attention to patients' readiness prior discharge, to explore causes of preventable readmissions, and better support for patient self-management.

Background Undertriage or the underestimation of the urgency of the condition of a person arriving in an emergency department (ED) represents a measure of quality care. Aim To estimate the prevalence of undertriage in a high complexity hospital of Argentina; to describe characteristics and mortality of these patients. Material and methods All consultations admitted to the ED during 2014 were analyzed. Those assigned to a lower level of admission risk (classified as Emergency Severity Index -ESI- 3 to 5) but required hospitalization in intensive care units (ICU) as the first hospitalization place were considered as an undertriage. A random sample of correctly categorized admissions (ESI 1 or 2), who were subsequently hospitalized in the ICU, was selected as a comparison group. Results The global undertriage prevalence was 0.30% (316/104,832). Among patients admitted to the ICU, the prevalence was 21% (316/1,461; 95% confidence intervals (CI) 19-24). The 316 patients whose severity was underestimated had a median age of 73 years, and admitted between 7 a.m. and 9 p.m. in a greater proportion. Overall hospital mortality was 8.9% (95% CI 6.78-11.38), and all deaths occurred after the patient was transferred from the emergency room. There were no differences in mortality between patients with correct triage or undertriage (11 and 7% respectively, p = 0.09). No differences were observed either in the total number of critical interventions during care in the first 24 hours. Significant differences were observed in requirements for mechanical ventilation (11 and 4% respectively, p = 0.01), orotracheal intubation (10 and 5% respectively p = 0.01) and non-invasive ventilation (8 and 4% respectively, p = 0.05). Conclusions Undertriage rate in this series was low, but it can be improved.

Resumen Objetivo Describir la evolucion de 2 indicadores (de proceso y de calidad) relacionados con la toma de hemocultivos (HC) en la Central de Emergencias de Adultos del Hospital Italiano de Buenos Aires y describir la variacion de los mismos tras la implementacion de una intervencion educativa en mayo de 2016 para el personal de la salud acerca de la indicacion apropiada de HC y la tecnica adecuada para su extraccion. Materiales y metodos Se diseno una cohorte retrospectiva que incluyo la totalidad de consultas a la Central de Emergencias de Adultos durante 2015-2016. Se considero indicador de proceso la tasa de solicitud de HC, e indicadores de calidad, el porcentaje de HC contaminados y la tasa de verdaderos positivos. Ambos se midieron de manera mensual y prospectiva durante el periodo del estudio. Resultados La tasa ajustada anual de solicitud de HC fue del 4,9% (IC 95% 4,8-5) en 2015 y del 2,9% (IC 95% 2,8-2,9) en 2016. La tasa de HC contaminados fue del 4,5% en 2015 y del 4,3% postintervencion, mientras que los verdaderos positivos fueron un 8,3% en 2015 y un 12% postintervencion. Conclusiones Estos hallazgos demuestran la efectividad de la intervencion y la importancia de realizarlas periodicamente.

Crowding in Emergency Departments (ED), results from the imbalance between the simultaneous demand for health care and the ability of the system to respond. The NEDOCS scale (National Emergency Department Crowding Scale) measures the degree of crowding in an ED. Aim: To describe ED Crowding characteristics, using the NEDOCS scale, in an Argentinean hospital. Material and Methods: A retrospective cohort study was conducted with all adult patient consultations between July 2013 and July 2014 at the ED of Hospital Italiano de Buenos Aires. We included all hours in the analysis period (365 days x 24 h = 8,760). The NEDOCS value was calculated for each hour using an automatic algorithm and was quantified in a six points score. Levels 4 (overcrowded), 5 (severely overcrowded) and 6 (dangerously overcrowded) were defined as overcrowding. Contour plots analysis was applied to identify patterns. Results: During the study period, 124,758 visits to the ED were registered. Overcrowding was present in 57.7% (5,055) of the analyzed hours. A predominance of scores between four and five was observed between 10:00 and 24:00 hours. The months with predominance of overcrowding were June, July and August (southern winter). Conclusions: The calculation of the NEDOCS score and the analysis of its temporal distribution are highly relevant to identify opportunities for improvement and to develop mechanisms to prevent the highest categories of overcrowding

Purpose The translation of deep learning (DL) techniques from research to effective clinical implementations has to overcome an important gap between the DL-development setting and the daily clinical practice. The purpose of this work was to carry out a proof-of-concept study of a DL tool for chest x-rays (CXR) at the emergency department (ED) of our health institution, to measure changes in the performance compared to the retrospective test reported in a prior study; and to compare the model with ED physicians, as they are the intended users of this system. Materials and methods We collected all CXR studies performed during April 2020 in the ED of a 650-bed university hospital, obtaining 508 CXRs from 499 patients. No manual selection or enrichment method were applied. We built a reference standard based on the diagnosis of three senior radiologists and used it to compare the DL model with ED physicians. Results The model showed a sensitivity of 0.853 and specificity of 0.715 for abnormal findings detection, and an area under the ROC curve of 0.784 (95% CI: 0.746–0.822), which is significantly lower than the value of the prior retrospective test. However, it is significantly higher than the 0.598 (95% CI: 0.54–0.62) value obtained by ED physicians (p Conclusion The DL model showed lower evaluation metrics on real-world emergency department images than what was previously observed in digital tests. These findings caution against overconfident in-silico performance estimates and highlight the importance of proof-of-concept studies of AI-based diagnostic tools to better approach real clinical settings. Despite its suboptimal performance, the algorithm showed significantly better performance than Emergency Department physicians for the detection of abnormal findings, which suggests there is room for conducive human-AI collaboration in real-world clinical scenarios.

Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases, such as Guillain-Barré syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aims to determine the association between these arboviruses and GBS in a Mexican population and to establish the clinical characteristics of the patients, including the severity of the infection. A case-control study was conducted (2016/07/01-2018/06/30) in Instituto Mexicano del Seguro Social (Mexican Social Security Institute) hospitals, using serum and urine samples that were collected to determine exposure to ZIKV, DENV, CHIKV by RT-qPCR and serology (IgM). For the categorical variables analysis, Pearson’s χ2 or Fisher exact tests were used, and the Mann-Whitney U test for continuous variables. To determine the association of GBS and viral infection diagnosis through laboratory and symptomatology before admission, we calculated the odds ratio (OR) and 95% confidence intervals (95%CI) using a 2x2 contingency table. A p-value ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. The association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89–73.01, p = 0.047), as well as laboratory evidence of ZIKV infection (OR, 16.45; 95% CI, 2.03–133.56; p = 0.001) or Flavivirus (ZIKV and DENV) infection (OR, 6.35; 95% CI, 1.99–20.28; p = 0.001) was observed. Cases of GBS associated with ZIKV demonstrated a greater impairment of functional status and a higher percentage of mechanical ventilation. According to laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV exhibited a more severe clinical picture. Cases with co-infection were not found., Author summary Dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) are considered as emerging or re-emerging viruses. Recently, these viruses have produced major epidemics in tropical climate urban centers, and have been associated with neurological manifestations, including Guillain-Barre syndrome (GBS), which causes muscle weakness, unstable gait, and decreased or absent musculoskeletal reflexes. This study aims to investigate the association between these viral infections and GBS. A case and control study was conducted nationwide, including 97 cases of GBS and 184 controls matched by age, gender, and locality, but not the disease. The study shows a positive association between GBS cases and ZIKV or ZIKV and DENV infection. GBS cases associated with ZIKV depicted a more severe clinical picture (more impairment of functional status, incapacity, and a higher percentage of mechanical ventilation). Finally, the symptoms of suspected ZIKV disease prior to the development of GBS were similar to some previous reports. The impact of the interaction of these three arboviruses, particularly ZIKV, on the health of the Mexican population was less than expected. The Mexican experience could be useful for other populations.

Consumer demand for product differentiation between GM and non-GM “milanesa de soja” – a broadly consumed soya based product in Argentina - is analyzed by estimating consumer's WTP for a non-GM “milanesa de soja” using a double bound dichotomous choice contingent valuation method on a sample of 557 Argentinian consumers. Heterogeneity in consumers' WTP is taken into account by incorporating consumer's views on the risks and benefits associated with GMOs; consumer's subjective and objective knowledge on GMOs; consumer's relatedness to agriculture along with their socio-demographic characteristics into the analysis. Product differentiation for non-GM “milanesa de soja” was supported by consumers who tend to perceive risks associated with GMOs while not perceiving their potential associated benefits. This type of consumers would be willing to pay a 50% premium on the current price for a non-GM “milanesa de soja” (ARS $89.78). On the other hand, consumers who are more supportive of GMOs would be willing to pay less than the current price, ARS $60.00, for a non-GM “milanesa de soja” (ARS $56.97). Consumers who hold more objective knowledge on GMOs were found to be less supportive of product differentiation. Income and gender were found to be related to consumer's WTP for non-GM “milanesa de soja”. Overall, oduct di support for prfferentiation was found from consumers who perceived GMOs as a risky technology and do not appreciate its associated benefits. This support for product differentiation measured in monetary terms would need to be set side by side with the implementation costs of regulation (e.g. labelling) before its implementation.

Human respiratory syncytial virus (HRSV) is a member of the Paramyxoviridae family, which causes lower respiratory tract infections in neonates and children younger than 5 years. Here, we report the complete genome sequence of HRSV, isolated from a nasopharyngeal swab of a pregnant woman with cardiac complications.