Objective. Spirometry is the gold standard among pulmonary function tests, with acceptability criteria established to ensure reliable results. However, variability in the interpretation of spirometry by trained reviewers remains unexplored. This study assessed agreement among trained reviewers regarding spirometric acceptability and its components, including the number of acceptable maneuvers, predominant defect, and repeatability. Methods. Spirometries from 3,982 adults (≥40 years) participating in an epidemiological study across six cities in Argentina were independently reviewed by junior reviewers (JRs) and adjudicated by senior reviewers (SRs), following the 2005 ATS/ERS guidelines. Agreement was analyzed using Cohen’s kappa, McNemar’s test, and proportion comparisons. Results. A total of 7,964 pre- and post-bronchodilator spirometries were analyzed. Agreement on overall acceptability between JRs was 76% and 84% in two independent reviewer teams (RvTa and RvTb, respectively). Agreement on specific defects was highest for numerical criteria, such as insufficient expiratory time (κ=0.61) and excessive back-extrapolated volume (BEV; κ=0.52), but lower for subjective criteria, including weak effort (κ=0.19) and cough in the first second (κ=0.36). No agreement was observed for glottic closure (κ=0). SR adjudication increased the proportion of acceptable tests from 54% to 65%. Conclusions: Reviewer variability significantly affects spirometric acceptability, with numerical criteria achieving higher agreement than subjective assessments. These discrepancies have implications for large-scale studies, data quality, and automated algorithm development. Cross-checking reviews is recommended to enhance reliability. Further standardization of acceptability criteria is warranted. Keywords: spirometry
En este artículo buscamos presentar un balance público sobre el grado de cumplimiento del Plan Provincial de Salud Mental 2022-2027, instrumento central de ordenamiento de la reforma bonaerense en salud mental, en lo que hace la transformación del sistema de atención con base en la comunidad, integral y desde una perspectiva de derechos humanos. Hace muy poco realizamos una primera exposición de este balance junto al Gobernador Axel Kicillof y al Ministro de Salud Nicolás Kreplak, en un ámbito que, desde hace seis años, se consolidó como un espacio colectivo de síntesis, debate y seguimiento de la reforma: las Jornadas Provinciales de Salud Mental y Consumos Problemáticos. En esta ocasión, se trató de las VI Jornadas, realizadas el 9 de octubre de 2025 bajo el lema Ante la complejidad actual, organizar la salud.
Introduction: After the marketing approval of a medicine, pharmacovigilance monitoring must be carried out at an international level and the necessary measures must be adopted to reduce the risk that its use may present. Restrictive measures are not taken with the same speed in all countries and there are differences in withdrawal patterns. Objectives: Identify medicines that have been withdrawn from marketing for safety reasons in countries with health reference agencies (SRA), between January 2014 and June 2023. Establish if these medicines were withdrawn from the market in Argentina. Methodology: Search for information on SRA, National Administration of Food Drugs and Medical Technology (ANMAT) websites and secondary sources. For each medication withdrawn by any SRA, the validity of the marketing certificate and regulatory actions in Argentina were verified. Results: In countries with SRA health agencies, 31 medications were withdrawn for safety reasons. Of these, in Argentina, 7 were identified with a valid marketing certificate, another 7 were withdrawn from the market mostly by the manufacturing laboratories, 14 were never marketed and no data was obtained for 3. Conclusion: In Argentina, medications were identified that were withdrawn from other countries and continue to have a valid marketing certificate. The number of regulatory actions related to safety aspects in our country was lower than those of countries with SRA. It is necessary to strengthen the pharmacovigilance system, and for ANMAT to apply measures that reduce the risk associated with the use of the questioned medications.
Introduction: This article presents information on VL in Argentina and analyzes the background of surveillance policies, human cases, and canine infection, selecting the province of Salta as a case study. Objective: To analyze a health surveillance policy for VL canine reservoirs, called “Co-responsibility commitment act” (ACo), implemented from the federal level, in conjunction with the province of Salta, in 2023. Method: Combines quantitative and qualitative techniques. The quantification and epidemiological description 2018–2024 were carried out with records from the National Surveillance System SNVS 2.0. For qualitative purposes, between November and December 2023, semistructured interviews were recorded with an intentional selection sample made up of the 3 provincial public officials who had human visceral leishmaniasis (HVL) and canine visceral leishmaniasis (CLV) among their duties. Interface analysis of this health policy was carried out. Results: In Salta, the ACo was implemented with significant territorial coverage. The application made explicit the gaps between the objectives of the national disease program and the local socio-territorial complexity. Distancing from the expectations placed in its national design, the information collected in the ACo did not facilitate the health monitoring of infected dogs or the domestic units that house them. Conclusions: The three provincial agencies linked to VL surveillance have a differentiated use of the ACo, and the minutes are not attached to the national computer registry (SNVS 2.0). The ACo is more efficient in tracking LVc+ dogs in urban transmission contexts than in satellite dispersal scenarios. ACo has two limitations: it does not generate monitoring information for the SNVS 2.0 and the prescriptive assumption of responsible tenure hides risk determination processes such as social inequality and cultural diversity.
Abstract Background Dengue is an emerging disease in Argentina due to the colonization of Aedes aegypti, the mosquito vector. Buenos Aires Province is the biggest and most populated district in Argentina, suffering dengue outbreaks of growing magnitude. During epidemic periods, pyrethroid insecticides are used in this country to control adult mosquitoes. Pyrethroid resistance in dengue vectors has been reported worldwide, making it necessary to implement resistance management strategies. The voltage-gated sodium channel is the target site of pyrethroids. Mutations in the gene encoding this protein, called kdr mutations, are usually the molecular cause of pyrethroid resistance in insects. In Ae. aegypti from the Americas, three kdr substitutions were described: V410L, V1016I, and F1534C. The diagnostic of kdr mutations is recommended for the early detection of pyrethroid resistance as well as the consequent planning of evidence-based control policies. Methods We distributed ovitraps across 16 localities in Buenos Aires Province, collecting 22,123 eggs. A total of 522 mosquitoes were genotyped in positions 1016 and 1534 of voltage-gated channel using multiplex high-resolution melting and/or TaqMan probe methods. A subset of 449 samples was also genotyped by a singleplex high-resolution melting method developed ad hoc and/or Sanger sequencing. Results We have documented, for the first time to our knowledge in the central region of Argentina, the presence of the 1016Ikdr + 1534Ckdr allele. Additionally, our study reports the first identification of the V410L mutation in central Argentina. These results underscore a growing trend of pyrethroid resistance in Ae. aegypti, fueled by the widespread use of these insecticides. Conclusions We detected 1016Ikdr + 1534Ckdr and 410Lkdr mutations in central Argentina for the first time and improved the processivity and accuracy of kdr genotyping methods. The results are both a tool for resistance monitoring and a sign of alarm to direct efforts towards finding sustainable methods for vector control to complement or replace pyrethroids. Joint efforts between academia and authorities to develop and implement public policies for vector control are a productive way to transfer scientific results for their application in public health. Graphical Abstract
