Papers by Laura Antonietti
Argentine Journal of Cardiology, Jun 19, 2013
Síndromes coronarios agudos-Género-Cardiopatía isquémica-Mujeres IAM Infarto agudo de miocardio S... more Síndromes coronarios agudos-Género-Cardiopatía isquémica-Mujeres IAM Infarto agudo de miocardio SCA-SSTE Síndrome coronario agudo sin SCA Síndrome coronario agudo segmento ST elevado
Mechanistic approaching study in COVID-19 patients treated with high doses of vitamin D
Exploration of Medicine
Aim: To evaluate angiotensin II (Ang II) and Ang-(1-7) levels and the cytokine profile in patient... more Aim: To evaluate angiotensin II (Ang II) and Ang-(1-7) levels and the cytokine profile in patients hospitalized with mild coronavirus disease 2019 (COVID-19) and contrast them with patients with identical clinical conditions but treated with high doses of vitamin D (vitD). Methods: From the 218 patients recruited (ClinicalTrials.gov NCT04411446), 16 participated in this sub-study and were randomized to a single oral dose of 500,000 IU vitD (n = 10) or placebo (n = 6). Plasmatic Ang II and Ang-(1-7) levels were determined by radioimmunoassay and interleukins (ILs) 1, 6, 8, and 10 and tumor necrosis factor alpha (TNF-α) by enzyme-linked immunosorbent assay before and after treatment. Parallel, serum 25-hydroxyvitamin D3 (25-OH vitD) concentrations as vitD status was measured by a chemiluminescence immunoassay. Results: A trend towards an increase in Ang-(1-7) and a decrease in Ang II levels were observed in placebo- and vitD-treated COVID-19 patients compared to baseline values. There...
PLOS ONE
Background The role of oral vitamin D3 supplementation for hospitalized patients with COVID-19 re... more Background The role of oral vitamin D3 supplementation for hospitalized patients with COVID-19 remains to be determined. The study was aimed to evaluate whether vitamin D3 supplementation could prevent respiratory worsening among hospitalized patients with COVID-19. Methods and findings We designed a multicentre, randomized, double-blind, sequential, placebo-controlled clinical trial. The study was conducted in 17 second and third level hospitals, located in four provinces of Argentina, from 14 August 2020 to 22 June 2021. We enrolled 218 adult patients, hospitalized in general wards with SARS-CoV-2 confirmed infection, mild-to-moderate COVID-19 and risk factors for disease progression. Participants were randomized to a single oral dose of 500 000 IU of vitamin D3 or matching placebo. Randomization ratio was 1:1, with permuted blocks and stratified for study site, diabetes and age (≤60 vs >60 years). The primary outcome was the change in the respiratory Sepsis related Organ Failu...
BMJ Open
IntroductionThere is an urgent need to reduce the burden of non-communicable diseases (NCDs), par... more IntroductionThere is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions.Methods and analysisWe will apply systems thinking (a holistic approach to analyse the inter-relationship...
Desarrollo y Capital Humano en Salud
V Encuentro Latinoamericano de Metodología de las Ciencias Sociales (Mendoza, 16 al 18 de noviembre de 2016), 2016
Revista Panamericana de Salud Pública, 2020
Se propone un modelo conceptual sobre condiciones y medio ambiente de trabajo en salud que integr... more Se propone un modelo conceptual sobre condiciones y medio ambiente de trabajo en salud que integra la evidencia disponible para facilitar el diseño y la evaluación de intervenciones orientadas a mejorar la atracción, captación y retención del personal de salud en el primer nivel de atención de áreas rurales y remotas.Se consultó la evidencia teórica, empírica y testimonial para fundamentar la propuesta y se sintetizaron 15 modelos difundidos en los últimos 20 años. El artículo da cuenta de la diversidad de perspectivas y la complejidad que conlleva establecer las dimensiones que deben considerarse en una propuesta que sea útil para aplicar a las políticas de recursos humanos en salud.El modelo propuesto incluye cuatro categorías de componentes: factores del contexto externo, factores organizacionales, condiciones del empleo y del trabajo, y factores individuales. Los límites entre los componentes –así como el peso y la influencia de cada uno– varían en función de la relación entre e...
Relato de experiencia: Grupo de monitoreo del plan estratégico de un hospital público en Argentina
Fil: Garcia Munitis, P. Hospital de Alta Complejidad en Red El Cruce Dr. Nestor C. Kirchner. Serv... more Fil: Garcia Munitis, P. Hospital de Alta Complejidad en Red El Cruce Dr. Nestor C. Kirchner. Servicio de Pediatria. Florencio Varela, Argentina.
Medicina-buenos Aires, 2020
Fil: Ortiz, Zulma. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Ep... more Fil: Ortiz, Zulma. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Epidemiologicas; Argentina
American Journal of Physiology-Lung Cellular and Molecular Physiology, 2020
The COVID-19 pandemic has reached most of the countries worldwide causing death, which often resu... more The COVID-19 pandemic has reached most of the countries worldwide causing death, which often results from an inflammatory storm associated with severe acute respiratory syndrome (SARS). This has prompted researchers to seek specific novel and definitive treatments urgently. In this context, it is interesting to evaluate the preventive and therapeutic effects of existing pharmacological agents that could be useful. In this regard, vitamin D supplementation, particularly in individuals likely to be deficient, may be a promising option. Vitamin D is a hormone that modulates many of the same inflammatory and oxidative signaling pathways triggered during COVID-19. For example, vitamin D suppresses the actions of the renin-angiotensin system, which has a determining role in the pathophysiology of the inflammatory response related to COVID-19. This paper analyzes the evidence that vitamin D supplementation might be a valuable preventive/therapeutic measure in groups at risk for or infected...
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Medicina, 2020
The COVID-19 pandemic affected the organization of health services and had consequences for healt... more The COVID-19 pandemic affected the organization of health services and had consequences for health teams, according to the pre-existing safety and working conditions. During the first week of April 2020, a cross sectional study was carried out with a qualitative-quantitative approach. The aim was to explore the conditions determining the organizational climate: leadership, communication, institutional resources, cohesion/conflict management, and training; and how these were perceived by health personnel to deal with the pandemic. A total of 5670 healthcare workers participated in an online survey and 50 were interviewed, from all subsectors of the Argentinean health system (public, private and union-health insurance); 72.9% were women, 51.4% were physicians, and the predominant age group was under 40 years. In the qualitative sample (interviews), 52% were men, 62% were physicians, and the average age was 44.8 years. The dimensions of the organizational climate were stratified and fi...
Valor pronóstico del ecocardiograma con strain bidimensional por speckle tracking en pacientes con amiloidosis asociada a transtiretina
Trabajo presentado en la 13o Jornadas Cientificas y de Gestion realizada durante los dias 10 y 11... more Trabajo presentado en la 13o Jornadas Cientificas y de Gestion realizada durante los dias 10 y 11 de Diciembre de 2020, en el Auditorio Ramon Carrillo del Hospital de Alta Complejidad en Red El Cruce.
Vitamin D supplementation: An alternative to enhance the effectiveness of vaccines against SARS-CoV-2?
Vaccine, 2021
Trials, 2021
Objectives To evaluate whether a single high dose of oral cholecalciferol improves the respirator... more Objectives To evaluate whether a single high dose of oral cholecalciferol improves the respiratory outcomes as compared with placebo among adults COVID-19 patients at moderate risk of clinical complications. Trial design The CARED trial is an investigator-initiated, multicentre, randomized, parallel, two-arm, sequential, double-blind and placebo-controlled clinical trial. It was planned as a pragmatic trial since the inclusion criteria are broad and the study procedures are as simple as possible, in order to be implemented in the routine clinical practice in general wards in the pandemic setting and a middle-income country context. The sequential design involves two stages. The first stage will assess the effects of vitamin D supplementation on blood oxygenation (physiological effects). The second stage will assess the effects on clinical outcomes. Participants Participants of either gender admitted to general adult wards in 21 hospital sites located in four provinces of Argentina a...
Revista Panamericana de Salud Pública, 2020
Objetivo.Identificar y sistematizar la evidencia empírica disponible sobre factores e intervencio... more Objetivo.Identificar y sistematizar la evidencia empírica disponible sobre factores e intervenciones que inciden en las condiciones y medio ambiente de trabajo para incrementar la atracción, captación y retención de recursos humanos en salud en el primer nivel de atención de áreas rurales, remotas o desatendidas.Métodos.Revisión rápida de revisiones, seleccionadas según criterios de pertinencia, elegibilidad e inclusión con búsquedas en bases de datos electrónicas, de literatura gris y manual. Se empleó el AMSTAR I para evaluar la calidad de revisiones sistemáticas y un análisis temático para síntesis de resultados.Resultados.Se incluyeron 16 revisiones, una de las cuales contenía a su vez 14 revisiones. Del total, 20 revisiones analizaron factores y 9 evaluaron efectividad de intervenciones. La evidencia sobre factores es abundante, pero de limitada calidad. Los factores individuales, familiares y la “exposición rural previa” se asociaron a mayor captación; factores organizacionale...
Análisis de traslados interhospitalarios de pacientes críticos a un área de unidad coronaria de un hospital de alta complejidad
Revista Argentina de Cardiologia, 2017
Therapeutic Advances in Cardiovascular Disease, 2020
Background: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early ... more Background: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previous randomized trial assessing fixed-dose combination therapy has included patients early after a MI. We aimed to assess if a multicap containing four secondary prevention drugs increases adherence to treatment at 6 months after MI hospitalization. The study was designed as a randomized, parallel, open-label, controlled trial. Methods: Patients were randomized within 7 days of a MI to either multicap or control group. The multicap group received a capsule containing aspirin, atenolol, ramipril, and simvastatin. The control group received each drug in separate pills. The primary outcome was adherence at 6 months. We also measured blood pressure, heart rate, serum cholesterol levels, C-reactive protein, and platelet aggregation. Results: The study was stopped prematurel...
Investigación en Educación Médica, 2017
Actitud y habilidades del médico residente de pediatría en la enseñanza de los médicos internos d... more Actitud y habilidades del médico residente de pediatría en la enseñanza de los médicos internos de pregrado, experiencia en hospitales públicos y privados al noroeste de México
Assessment of Coronary Arteries of Patients with Takotsubo Syndrome using Multislice Computed Tomography: Lesions and Pathophysiological Inferences
Revista Argentina De Cardiologia, Jun 1, 2009
Revista Argentina de Cardiología, 2013
Introducción: Una particularidad de los síndromes coronarios agudos (SCA) es que su distribución ... more Introducción: Una particularidad de los síndromes coronarios agudos (SCA) es que su distribución impresiona tener aspectos cronobiológicos, ya que no se mantiene estable a lo largo del año y varía incluso según el día de la semana y la hora del día. No tenemos conocimiento de evidencia publicada acerca de la distribución de los casos de SCA acorde al día de la semana en nuestro país, por lo que se ignora si sigue un patrón determinado y cuáles podrían ser las variables asociadas. Objetivo: Analizar la distribución diaria de los casos de SCA y las eventuales diferencias en el tratamiento y la evolución clínica de los pacientes. Material y métodos: Se estudió el número y la evolución de SCA sin ST elevado (SCA no-STE, n = 6.277) y con ST elevado al ingreso (SCA-STE, n = 4.237) acorde al día de la semana mediante el análisis del registro Epi-Cardio 2006-2012. Resultados: La frecuencia fue mayor en los primeros días de la semana, descendiendo durante el fin de semana (global y SCA no-STE: p < 0,001; SCA-STE: p < 0,01), sin relación con la edad y el sexo. En los SCA-STE, la indicación y el tipo de reperfusión no tuvieron diferencias según el día de la semana. Conclusiones: La frecuencia de internaciones por SCA es mayor en los primeros días laborables y menor los fines de semana, sin diferencias en el uso de recursos complejos ni en la evolución inicial.
Archivos de Cardiología de México, 2014
Objective: The association between biochemical markers and left ventricular ejection fraction in ... more Objective: The association between biochemical markers and left ventricular ejection fraction in patients with myocardial infarction was not completely studied. Our goal is to study the association between biochemical markers and left ventricular dysfunction in patients with STelevation acute myocardial infarction. Methods: With an observational and prospective design we included patients with less than 24 h ST-elevation myocardial infarction. Leukocytes, glucose, B-type natriuretic peptide and T troponin were measured at admission, and creatine-phosphokinase and creatine-phosphokinase-MB were measured at admission and serially, and correlated with the ejection fraction estimated by echocardiography. Results: A total of 108 patients were included. The median left ventricular ejection fraction was 48% (interquartile range 41-57). Simple linear regression analysis showed that B-type natriuretic peptide (P = .005), peak creatine-phosphokinase-MB (P = .01), leukocyte count (P = .001) and glucose (P = .033) were inversely and significantly associated with the left ventricular ejection fraction. The other parameters showed no association. B-type natriuretic peptide (P = .01) and peak creatine-phosphokinase-MB (P = .02) were the only two variables significantly associated with the left ventricular ejection fraction in the multiple linear regression analysis. Both markers were significantly associated with a left ventricular ejection fraction < 50%, independently of other clinical variables. Conclusion: B-type natriuretic peptide and peak creatine-phosphokinase-MB showed significant association with left ventricular ejection fraction in the acute phase of ST elevation acute myocardial infarction. This association was independent of the presence of other biochemical markers and clinical variables related to ventricular dysfunction.
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Papers by Laura Antonietti