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Introducción: Existe escasa información y no actualizada sobre la presencia de triatominos en el departamento de San Martín, zona amazónica de nuestro país, y es importante actualizarla, ya que hay reportes recientes de casos de enfermedad de Chagas procedentes de la amazonía peruana cuyos vectores serían triatominos silvestres. Objetivos: Conocer la distribución geográfica de triatominos hematófagos en Huallaga y Picota, San Martín, Perú. Determinar los índices entomológicos, sus hábitos alimenticios y caracterizar los tripanosomatídeos que portan. Diseño: Investigación descriptiva observacional. Lugar: Red de Salud Huallaga y Picota, Laboratorio Regional de la Región de Salud San Martín. Laboratorios del Instituto Nacional de Salud. Participantes: Viviendas de 6 distritos de las provincia de Huallaga y 9 de Picota, del Departamento de San Martín. Intervenciones: La búsqueda de triatominos fue en 3 362 viviendas de áreas periurbanas y rurales. Mediante la prueba de precipitina, se determinó la fuente de alimentación. Se aisló tripanosomatídeos mediante infección en ratones Balb/C e inoculación en medio agar sangre, y por PCR se caracterizó el genoma por amplificación del espaciador intergénico del gen miniexón. Principales medidas de resultados: Determinar si Huallaga y Picota, San Martín, Perú, son zonas de riesgo de enfermedad de Chagas. Resultados: En 46 viviendas, de 3 362 muestreadas se capturó 53 triatominos adultos pertenecientes a Rhodnius pictipes (56,6%), Panstrongylus geniculatus (41,5%) y Eratyrus mucronatus (1,9%). Se reporta P. geniculatus por primera vez para las dos provincias. Los índices de infestación para ambas provincias fueron 1,4% y 3,8%, respectivamente, y corresponden al índice de infección natural; mientras que el índice de dispersión fue 30,1%. En R. pictipes se identificó cinco fuentes de alimentación (pollo, humano, perro, cobayo y gato) y en P. geniculatus un perfil alimentario mixto: perro/gato/pollo. Los Trypanosoma spp. aislados de R. pictipes, procedente de Sacanche (Huallaga), corresponden a TCI (350 pb); resultado similar se obtuvo en los 10 clones de este aislamiento. Conclusiones: Los resultados nos indican que, en las localidades estudiadas, R. pictipes y P. geniculatus estarían pasando por un proceso de domiciliación y que en las localidades de Huallaga R. pictipes sería el principal vector de Trypanosoma cruzi TC1; por lo que, dichas localidades estarían consideradas como zonas de riesgo de enfermedad de Chagas.

Introduction. The COVID-19 pandemic has brought to light the need for rapid diagnostic tests. The gold standard test is reverse transcription-polymerase chain reaction (RT-PCR). RT-PCR requires equipment and trained personnel, and results may take a long waiting time. The BD Veritor® System is a rapid chromatographic method used for the detection of severe acute respiratory syndrome coronavirus 2 antigen in symptomatic individuals. The primary objective of this study is to assess the sensitivity and specificity of the antigen test (AT) compared to the RT-PCR in the pediatric population. Population and methods. Prospective study with a diagnostic test. All children younger than 17 years in the first 5 days of symptom onset, who consulted between July 2021 and February 2022, were included. A minimum of 300 specimens was estimated to achieve an accuracy of ±8.76% and ±3.68% for sensitivity and specificity, respectively. Specimens were analyzed in parallel using both methodologies. Results. Of 316 paired samples, 33 were positive by both methods; 6 were positive only by RT-PCR. The specificity of the AT was 100%; sensitivity was 84.6%, with a positive and negative predictive value of 100% and 98%, respectively. Conclusions. The AT proved to be useful in the diagnosis of pediatric patients with COVID-19 in the first 5 days of symptom onset, although those with a negative AT and high clinical suspicion should confirm their result with a RT-PCR. Clinical trial registration: PRIISA.BA - Record number: 4912 - Date of registration: 07/07/2021., (Sociedad Argentina de Pediatría.)

SARS-CoV-2 infection in patients with hematological malignancies and hematopoietic stem cell transplants (HSCT) can be severe and with significant mortality. We carried out a prospective and observational study to describe the clinical and epidemiological characteristics and outcome of SARS-CoV-2 infection in patients with hematological malignancies and HSCT. Twenty adult patients were included with a median age of 58 years and a median Charlson score of 3. Infections were community-acquired and nosocomial in 60% and 40%, respectively, and 30% of the patients had a history of contact with a SARS-CoV-2 infected person. Sixty-five percent had pulmonary infiltrates, mostly with a ground-glass pattern on CT scan. Almost half of the patients had a severe and critical illness, and a high proportion received convalescent plasma as treatment. Twenty percent and 15% had complications and hospital infections, respectively, and had prolonged hospitalization expressed as median days of it. The 30-day mortality was 10%. SARS-CoV-2 infection in our population had a considerable clinical and epidemiological impact.

Objetivo: Medición de la eficacia y relevamiento de las complicaciones asociadas a la a realización de traqueostomía percutánea (TP) guiada por videobroncoscopia en un hospital universitario de alta complejidad. Materiales y métodos: Estudio observacional retrospectivo realizado entre mayo de 2017 y agosto de 2019. El criterio para la indicación de TP fue desvinculación prolongada de la ventilación mecánica en todos los casos. Incluyó pacientes mayores de 18 años en que se realizó TP electiva guiada por videobroncoscopia. Se registraron variables demográficas, APACHE II y días de ventilación mecánica previos a la TP. La eficacia del procedimiento fue evaluada en base a la tasa de éxito en la ejecución, la necesidad de conversión a técnica abierta. Asimismo, se registraron las complicaciones observadas. Resultados: Se evaluaron 235 procedimientos (149 hombres y 86 mujeres) en pacientes con edad media de 61 años ± 19, un score APACHE II 18 ± 8. La TP pudo ser ejecutada en forma rápida y satisfactoria en todos los pacientes sin requerimiento de conversión a técnica abierta. Se presentaron complicaciones tempranas en el 3,8% (9) de los casos. El sangrado menor fue la complicación más frecuentemente observada en 5 casos (2,1%), hipotensión en 3 casos (1,3%) e hipoxemia transitoria en un caso (0,4%). Asimismo el 2,1% (5) de los casos registró complicaciones tardías. Conclusión: La realización de TP mediante la técnica de dilatador único guiada por videobroncoscopia se describe como un procedimiento efectivo y seguro, que puede realizarse en unidades de cuidados intensivos con baja tasa de complicaciones., Objective: Measurement of the efficacy and complications associated with performing percutaneous tracheostomy (PT) guided by video bronchoscopy., Materials and Methods: Retrospective observational study conducted between May 2017 and August 2019. Adult patients who underwent elective PT guided by video bronchoscopy were included. The criteria for the indication of PT was prolonged weaning from mechanical ventilation in all cases. Demographic variables, APACHE II score and days of mechanical ventilation prior to PT were recorded. The efficacy of the procedure was evaluated based on the success rate in the execution, the need for conversion to open technique. Also complications observed were recorded., Results: 235 procedures (149 men and 86 women) were evaluated in patients with an average age of 61 years ± 19 and APACHE II score 18 ± 8. The PT was performed quickly and satisfactorily in all patients without conversion to open technique in any case. Complications occurred in 3.8% (9) of the cases. Minor bleeding was the most frequently observed complication in 5 cases (2.1%), hypotension in 3 cases (1.3%), and transient hypoxemia in one patient (0.4%). Also, 2,1% (5) of the cases presented late complications., Conclusion: Performing PT guided by video bronchoscopy is described as an effective and safe procedure that can be done in intensive care units with a low rate of complications., (Universidad Nacional de Córdoba)

Background: Death with a functioning graft (DWGF) is now one of the main causes of renal transplant (RTx) loss., Aim: To determine whether the causes of DWGF, characteristics of donors and recipients and complications of RTx have changed in the last two decades., Subjects and Methods: Cooperative study of a cohort of 418 kidney grafts performed between 1968 and 2010. Patients were divided into two groups according to whether their kidney transplants were performed between 1968 and 1992 (Group 1) or 1993 and 2010 (Group 2)., Results: Sixty eight patients experienced DWGF. Infections were the leading cause of DWGF in both groups (38 and 41%, respectively), followed by cardiovascular diseases (24 and 23% respectively), gastrointestinal disorders (21 and 26% respectively) and cancer (17 and 10% respectively). There were no significant differences in causes of death between the two groups according to the time elapsed since the renal transplantation. In patients in Group 1, the interval between diagnosis of renal failure and dialysis (HD) and the interval between the start of HD and kidney transplantation were significantly lower than in Group 2. The former had also an increased number of acute rejections in the first five years of kidney transplantation (p < 0.001). In Group 2, patients more often received their kidneys from deceased donors, had previous kidney transplantation, higher rate of antibodies to a panel of lymphocytes and an increased incidence of cardiovascular disorders after five years of RTx., Conclusions: The proportion of graft loss due to DWGF has increased over the last 2 decades, but its causes have not changed significantly. Infections are the most common causes of DWGF followed by cardiovascular and digestive diseases.

Molecular methods for human rhinoviruses (HRV) have increased the sensitivity in their diagnosis. HRV may cause acute respiratory infections (ARI) of the upper and lower respiratory tract. HRV infection during childhood is a predictor of asthma development. In this study, the HRV frequency in outpatient children with ARI was determined, and their clinical features and previous conditions were evaluated. A total of 186 respiratory samples of children under 6 year old attending the CEMIC pediatric emergency room from June 1, 2008 to May 31, 2010, were studied. Classical respiratory viruses were detected by immunofluorescence. A real time RT-PCR that amplifies part of the 5' non coding genomic region was used for HRV detection. Viral detection was obtained in 61% of children. The frequency was: 27% for HRV, 16% for respiratory syncytial virus (RSV), 9% for influenza, 8% for parainfluenza, 7% for metapneumovirus and 0.5% for adenovirus. Dual coinfection was detected in 8 children and HRV were the most frequent, detected in 4 of them. HRV circulated during the two year period of the study, with peaks during winter and spring. No clinical difference was observed between patients with or without HRV, except an increase percent of children with HRV without fever. HRV were the most frequent viruses detected in this population, mainly in children under 2 year old, the second cause of bronchiolitis after RSV and more frequently detected in children exposed to passive smoking (OR = 2.91; p = 0.012), and were detected as the sole etiologic agent in 28% of bronchiolitis.

Introduction: Acute respiratory infections (ARI) are a major cause of hospitalization particularly at the extreme ages of life., Objectives: To determine the viral diagnosis in children < 5 years old with ARI, seasonality, clinical and epidemiological characteristics., Population and Methods: A cross-sectional, descriptive and multicenter study was performed. Respiratory samples from patients with ARI hospitalized or outpatients with < 5 days of respiratory symptoms from June 2008 to May 2009 were studied for respiratory viruses. Clinical and demographic data were recorded., Results: A total of 347 patients were enrolled: 234 hospitalized and 112 outpatients. Hospitalized patients were younger compared with outpatients (8 vs. 19 months, p <0.001) and presented more frequently bronchiolitis (74% hospitalized vs. 24% outpatients) and pneumonia (14% hospitalized vs. 5% outpatients). Age was statistically associated with hospitalization (p= 0.01). Viral diagnosis was achieved in 81% hospitalized and 57% of outpatients. Rhinovirus was the most frequent followed by respiratory syncytial virus. The rest of respiratory viruses were observed with lower frequency. Viral circulation was observed throughout the whole year. The median length of stay was 3.5 days. Intensive care was required in 11% of hospitalized patients and 3% required mechanical ventilation. No deaths were recorded., Conclusions: The use of viral diagnostic techniques allowed the identification of an etiologic agent in most of the hospitalized patients and more than half of outpatients. The addition of RT-PCR for rhinovirus, allowed the identification of this etiologic agent. Viral circulation was observed throughout the whole year. Hospitalized patients presented bronchiolitis and pneumonia more frequently than outpatients.

In immunocompromised patients, diagnosis of Cytomegalovirus (CMV) active infection is of utmost importance for the initiation, monitoring and ending of antiviral therapy. Therefore, the presence of viral replication should be demonstrated. Isolation in tissue culture is one of the standard methods. The objective of the present paper was to compare two isolation procedures for CMV: conventional cell culture (CC) and rapid shell vial (SV) assay in human fibroblasts. A total of 584 clinical samples were studied between 1991 and 1998. CMV was isolated in 14.4% of the samples, 11.8% of which were positive by SV and 7.7% by CC. Out of 84 positive samples, concordance between both methods was observed in 36% of the cases. We found that 46% of the samples were positive only by SV, while 18% were positive only by CC. The average time required for obtaining the results by CC was 22.6 +/- 2.3 days. Out of the 69 samples positive by SV, 43% were already positive after 24 hours and the rest after 48 hours. These results indicate that SV was more sensitive and rapid than CC. The main advantage of CC, despite its time-consuming process, is the ability to recover the viral strain for both antiviral susceptibility phenotypical tests and strain characterization. Furthermore, in this study, absence of CC would have resulted in the loss of 18% of the positive diagnoses. In conclusion, simultaneous use of both methods is suggested in order to obtain a rapid result and the highest sensitivity.

Background: Microemulsion cyclosporine is a new pharmaceutical form whose intestinal absorption is more constant, resulting in a better bioavailability., Aim: To assess dose adjustments and variability of blood levels after the conversion of cyclosporine to microemulsion cyclosporine in renal transplant recipients function receiving cyclosporine-ketoconazole., Patients and Methods: Thirty four patients with more than one year after the transplantation, with stable renal function and receiving triple immunosuppression were studied. Conventional cyclosporine was changed to the microemulsion form maintaining the same daily dose. Drug serum levels, serum creatinine and blood pressure were measured within two to eight months after the conversion. Doses of microemulsion cyclosporine were adjusted to achieve serum levels of 150 +/- 40 ng/ml., Results: Microemulsion cyclosporine induced a slight initial increase in blood cyclosporine levels. Afterwards, levels were more stable than with conventional cyclosporine (165-185 and 145-210 ng/ml respectively) and the dispersion of values were lower (standard deviations of 70 and 100 ng/ml respectively). Twenty three patients did not require dose adjustments, in four it was reduced and in five it was increased. There were no changes in serum creatinine or blood pressure after the conversion., Conclusion: More stable serum levels without adverse reactions were obtained with microemulsion cyclosporine. Doses of cyclosporine need not to be changed during the conversion.

The purpose of this prospective study was to determine whether the course and prognosis of acute renal failure (ARF) in patients with and without sepsis are different. Two hundred fifty-two (8%) of 3086 consecutive patients admitted to a medical-surgical intensive care unit (ICU) developed ARE. One hundred forty-nine (59%) were septic and 103 (41%) were non-septic. No differences were found between groups regarding the incidence of oliguria, hyperkalemia, hypercatabolism, gastrointestinal bleeding, duration of oligria and renal deficit, severity of axotemia, dialysis requirements and duration of stay in the hospital. There were statistically significant differences between septic and non septic patients with respect of hyponatremia (67.8 vs 54.4%, p < 0.04), respiratory failure (68 vs 54%, p < 0.04), and thrombocytopenia (64 vs 48%, p < 0.02). Mortality in septic patients was higher than in non-septics (56 vs 42.7%, p < 0.009). Factors associated with increased mortality in ARF septic patients were respiratory failure, metabolic acidosis and oliguria while in the non-septics they were hepatic dysfunction, hyperkalemia, respiratory failure and infection acquired during the course of renal failure. We conclude that ARF developing in septic patients has a higher mortality than that of non-septic patients, whereas the incidence of hypercatabolism and oliguria was not different between both groups.

In order to determine the importance of Chlamydia trachomatis in infertility due to tubal occlusion, the prevalence of C. trachomatis antibody was studied in two populations of Argentine women, pregnant and infertile with tubal occlusion. IgG and IgM against C. trachomatis were determined by indirect immunofluorescence in McCoy cells infected with strain L2Bu434 of C. trachomatis. In infertile women, specific anti-C. trachomatis IgM was detected in 5 out of 32 (15.6%) and IgG in 20 out of 32 (75%). In pregnant women, specific IgM was detected in 4.8% (4/83) and IgG in 20.5% (17/83). The frequency of IgG detection was significantly higher in infertile than in pregnant women (p < 0.000). Thirteen out of 20 (65%) women who underwent laparoscopic examination had evidence of chronic inflammatory disease described as yellowish viscous cysts resembling "frog eggs" in Douglas, utero and/or perihepatitis. Twelve out of fourteen (86%) infertile women with positive serology for C. trachomatis presented one or more of these laparoscopic findings. C. trachomatis antigen was detected in 2 out of 10 tubal biopsies by direct immunofluorescence with monoclonal antibodies although isolation in McCoy cells was negative. Our results show the importance of C. trachomatis in infertility due to tubal occlusion and the need of C. trachomatis diagnosis in routine gynecologic analysis to prevent infertility and neonatal infection.

Infection of newborn immunocompetent (nu/+) mice with the XJ prototype strain of Junin virus, etiological agent of Argentine Hemorrhagic Fever, produces a lethal meningo-encephalitis due to cellular immune response. The same strain inoculated into athymic (nu/nu) mice produces an asymptomatic persistent infection. The purpose of this work was to determine the nu/nu mice response when infected with XJCl3, an attenuated Junin virus strain, since this strain behaves differently to the pathogenic prototype in various experimental hosts and humans. Fifty five suckling nu/nu mice and 45 nu/+ were inoculated intracerebrally with 10(3) PFU of the XJCl3 strain. Twenty nu/nu and 20 nu/+ were kept as uninoculated controls. Similar percentages of mortality were recorded for nu/nu and nu/+ infected animals (86 and 87%). In contrast, no morbi-mortality was detected in control animals which were kept in the same animal room. High virus titers were detected in brains and lungs of infected nu/nu at 7, 14, 21 and 70 days post-infection(pi). Virus titers in blood were 1 log lower than those found in organs. Immunohistochemical studies of brains showed viral antigen in the cytoplasm of cortical neurons at 21 and 70 days pi. An interstitial pneumonitis was detected in lungs of infected nu/nu at 7 and 21 days pi, while no lesions were observed in brains and spleens. Results show that the XJl3 strain behaves in a very different way in newborn nu/nu mice as the XJ prototype strain. Further studies are necessary to determine the pathogenic mechanisms involved.

The appearance of jaundice during a septic process is usually associated to multiple organ failure and a high mortality rate. Among 17 septic patients followed prospectively, we found 11 with hepatic dysfunction. Abnormal levels of bilirubin and alanine-aminotransferase were found. Glutamine concentration in spinal fluid was 26 +/- 19.4 mg/dl vs 9.43 +/- 2.41 in patients without liver failure (p less than 0.05). Significant correlations were found among levels of bilirubin and glutamine (r = 0.83), creatinine (r = 0.708), number of platelets (r = 0.778) and between glutamine and creatinine (r = 0.708). Patients with liver failure presented a higher rate of renal failure and thrombocytopenia (p less than 0.01) and a higher mortality rate. These findings confirm that liver failure is associated to multiple organ failure and thrombocytopenia. It may be related to small vessel occlusion.

We report two diabetic patients who developed lactic acidosis following the use of Buformin. Treatment consisted of mechanical ventilation, massive bicarbonate administration, circulatory support with dopamine and peritoneal dialysis. Despite this, both patients died.

Two Cebus sp surviving acute Junin virus infection, one after intramuscular inoculation with pathogenic XJ and the other after intracerebral inoculation with XJ Clone 3, failed to exhibit persistent infection. Although treatment with immunosuppressive drugs was carried out, no Junin virus was detected in blood or organs in spite of blind passages in mice for the former as well as cocultivation with permissive Vero cells for the latter. Viremia was also ruled out by immunofluorescence on BHK/21 cell culture. These findings correlate with the lack of long-lasting virus in blood observed in humans following the acute phase of Argentine Hemorrhagic Fever.

The usefulness of a method for detection of antibodies against Junin virus in whole blood was tested. N: NIH adult mice were inoculated with 10(3) PFU of attenuated XJ-Clon 3 Junin virus strain by intraperitoneal route and blood was obtained by retro-orbital puncture at 21 days post-infection. One blood aliquot (50 microliters) was collected in tubes containing a stabilizer solution for whole blood and another was processed for serum obtention. Immunofluorescent antibodies were tested on spot slides of a BHK/21 cell line persistently infected with Junin virus. High antibody titers (1/64 to 1/256) were detected in both whole blood and serum, with 66% coincidence between both procedures. These results show that the method of detection of antibodies in whole blood would be useful to test quickly for anti-Junin virus antibodies in seroepidemiologic studies, in endemic areas.

Rhabdomyolysis was evaluated by measurement of total creatine kinase (CK) and lactic dehydrogenase (LDH) in 19 patients with severe sepsis; 12 developed acute renal failure (Group B) and 7 did not (Group A). Results were compared to 7 patients with trauma (Group C) and 6 patients with chronic renal failure and minor infections (Group D). CK was higher (p less than 0.005) in Group B than in A. Results in Group C were similar to those in A. Elevation of CK correlated to increases in creatinine (r = 0.655, p less than 0.005). CK levels of Group D patients were lower than those of Group B. Blood pressure, lactate and pO2 were similar in both groups but thrombopenia was noted in Group B patients. Our results suggest that rhabdomyolysis and thrombopenia play a role in the development of renal failure in patients with severe sepsis.

We evaluated the results of peritoneal lavage and conservative surgery in 64 consecutive patients with severe acute pancreatitis, 73.4% of patients had associated cholelithiasis. Early resective surgery, specially in patients with necro-hemorrhagic pancreatitis and respiratory failure, was associated to a high mortality. Peritoneal lavage was started earlier in survivors and was effective in decreasing pain and amylase levels, but not in correcting hypoxemia. 29% of patients died in shock, which developed early and was mostly toxic in patients older than 50 as opposed to septic in younger patients. Actuarial survival rate was 50% at 1 month. Poor risk factors included admission after 48 hr, resective surgery, age greater than 50 years and failure to use peritoneal lavage.