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Objetivos: El angioedema hereditario es una enfermedad poco frecuente. Durante los últimos años se han desarrollado muchas investigaciones y registrado avances con el objetivo de entender mejor la fisiopatología y optimizar la atención a los pacientes. Diversos grupos de trabajo internacionales han intentado clarificar y normalizar el cuidado de pacientes con angioedema hereditario, lo que se ha reflejado en guías y consensos. Consideramos necesario desarrollar un documento de consenso con recomendaciones para el diagnóstico y tratamiento del angioedema hereditario en Argentina. Metodología: Un grupo de expertos de Argentina, conformado por especialistas en Alergia e Inmunología mediante metodología de ronda de encuestas a distancia y reuniones presenciales llevó adelante la elaboración del consenso pretendido. Resultados: Se establecieron recomendaciones basadas en la evidencia publicada y en el criterio de los expertos participantes. Las recomendaciones se enfocaron en el diagnóstico, tratamiento y profilaxis de las crisis a corto y largo plazo, control de situaciones especiales y consideraciones del sistema de salud en Argentina. Conclusión: Las recomendaciones establecidas en este consenso permitirán optimizar la atención médica de los pacientes con angioedema hereditario en Argentina.

Background: Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon’s experience. Aims: The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring. Methods: A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic–chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation. Conclusions: In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.

La rinitis alérgica (RA) es la enfermedad alérgica más frecuente. La prevalencia en niños y adolescentes de Argentina oscila entre 22.3 y 34.9 %. Ante esto, integrantes de los comités científicos de pediatría y rinitis de la Asociación Argentina de Alergia e Inmunología Clínica (AAAeIC) revisaron evidencia científica para actualizar las normativas terapéuticas de esta patología en la población pediátrica. La clasificación y categorización de la RA se encuentra actualmente en plena revisión en todo el orbe. Es necesario realizar un diagnóstico diferencial con otras rinitis no alérgicas en los niños, y confirmar la RA con base en la historia clínica, el examen físico, la determinación de biomarcadores o pruebas cutáneas. El tratamiento no farmacológico incluye la educación y pautas de control ambiental para alérgenos como ácaros, hongos anemófilos, epitelio de animales y pólenes. Se propone un tratamiento farmacológico escalonado de acuerdo con el control de la enfermedad. Los antihistamínicos de segunda generación no sedativos son la primera línea de tratamiento. La asociación con descongestivos orales no se recomienda en menores de cuatro años. Los corticoides nasales inhalados son de primera elección en formas moderadas y graves. El presente documento alerta a los pediatras sobre la importancia del diagnóstico precoz, el uso racional del tratamiento farmacológico escalonado y la inmunoterapia específica en niños.

Antecedentes: El Angioedema Hereditario es una enfermedad genética rara; se manifiesta principalmente con edema cutáneo y/o mucoso. Pequeños traumas pueden desencadenar eventos potencialmente fatales. En Angioedema Hereditario tipo I y tipo II, se puede hacer profilaxis a corto plazo con concentrado plasmático de C1 Inhibidor. En Angioedema Hereditario con C1 Inhibidor normal, la profilaxis aún no está estandarizada pero este podría ser beneficioso. Reporte de caso: Mujer de 69 años, con diagnóstico genético de angioedema hereditario con C1 inhibidor normal, consultó a la Sección de Alergia por requerir exodoncias dentarias múltiples. El procedimiento se realizó bajo anestesia general, utilizándose como profilaxis 1000U de concentrado de C1 inhibidor derivado del plasma una hora antes. Cursó el postoperatorio en terapia intensiva con buena evolución. Conclusiones: Resaltamos la posibilidad de utilizar con éxito el concentrado de C1 inhibidor derivado del plasma como profilaxis, en pacientes con Angioedema Hereditario con C1 inhibidor normal.

Làtex; Gestió; A nivell mundial Latex; Management; Wordwide Látex; Gestión; A nivel mundial Despite the efforts made to mitigate the consequences of this disease, natural rubber latex allergy (NRLA) continues to be a global health problem and is still considered one of the main worries in the working environment in many countries throughout the world. Due to thousands of products containing latex, it is not surprising that the current statistics suggest that prevalence remains high among healthcare workers and susceptible patients. In developed countries, reduction in the prevalence of IgE-mediated allergy to latex proteins from gloves may lead to lax attention by health care personnel. On the other hand, this situation is different in developing countries where there is a lack of epidemiological data associated with a deficit in education and awareness of this issue. The aim of this review is to provide an update of the current knowledge and practical recommendations regarding NRLA by allergologists from different parts of the world with experience in this field. The authors have not received any funding to prepare the manuscript.

Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care.

There are very few studies about the prevalence of allergic rhinitis in Argentina.To determine the prevalence of allergic rhinitis in a population of inhabitants between the ages of 5 and 44 in Argentina.A cross-sectional national study in which a self-reported questionnaire was used. The included participants are between the ages of 5 and 44 and they reside in urban areas. The information was collected by phone.3200 participants were surveyed: 51.8% were women, 37.6% were between the ages of 5 and 19, and 62.4%, were between the ages of 20 and 44. The global prevalence of symptoms of allergic rhinitis was of 20.5%; the most frequent symptoms were sneezing (58.5%) and nasal congestion (51.4%). Overall, 44.3% of the participants had a family history of allergies. Allergic rhinitis was more frequent in women; the prevalence was of 22.3% in the group of participants between the ages of 5 and 19, and of 19.4% in the group of participants between the ages of 20 and 40 (p=0.0545); 63.8% of participants with symptoms did not have a medical diagnosis.The results of this first cross-sectional national survey have confirmed the high prevalence of self-reported symptoms of allergic rhinitis in adults and children in Argentina, particularly in women.Antecedentes: Existen pocos estudios sobre la prevalencia de rinitis alérgica en Argentina. Objetivo: Determinar la prevalencia de rinitis alérgica en una población entre cinco y 44 años de edad en Argentina. Métodos: Estudio transversal nacional en el que se utilizó un cuestionario autoinformado. Se incluyeron participantes entre cinco y 44 años de edad residentes en áreas urbanas. La información se recolectó telefónicamente. Resultados: Se encuestaron 3200 participantes: 51.8 % del sexo femenino, 37.6 % tenía entre cinco y 19 años y 62.4 % entre 20 y 44 años. La prevalencia global de síntomas de rinitis alérgica fue de 20.5 %; los síntomas más frecuentes fueron los estornudos (58.5 %) y la congestión nasal (51.4 %). En general, 44.3 % de los participantes tenía antecedentes familiares de alergia. La rinitis alérgica fue más frecuente en las mujeres; la prevalencia fue de 22.3 % en el grupo de cinco a 19 años y de 19.4 % en el de 20 a 44 años (p = 0.0545); 63.8 % de los participantes con síntomas no tenía diagnóstico médico. Conclusiones: Los resultados de esta primera encuesta transversal nacional confirman la alta prevalencia de síntomas autoinformados de rinitis alérgica en adultos y niños en Argentina, especialmente en las mujeres.

Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up.Dados los avances sobre mucopolisacaridosis I con posterioridad al consenso publicado en la Argentina por un grupo de expertos en 2008, se revisan recomendaciones respecto a estudios genéticos, seguimiento cardiológico, cuidado de la vía aérea, alertas sobre aspectos auditivos, de la patología espinal y neurológica. Se hace revisión de la terapéutica actual y se enfatiza en la necesidad de un diagnóstico y tratamiento precoces, así como de un seguimiento interdisciplinario.

Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.

This document summarizes the aims of GA2 LEN/HAEi Angioedema Centers of Reference and Excellence (ACAREs) and elaborates the requirements that ACAREs must fulfill to become certified. It also provides (see Appendix S1) background information on GA2LEN and HAEi, including HAEi member organizations and regional patient advocates, on why we need an Angioedema Center of Reference and Excellence (ACARE) program and network, and on the accreditation and certification process, governance and funding, and on the interaction with other GA2LEN networks of centers of reference and excellence. The protocols, aims, requirements, and provisions related to becoming a certified CARE are based on (a) the experience of the GA2LEN UCARE network and (b) input from angioedema patients, general practitioners, and angioedema specialists.

The aim of the present study was to evaluate the rheumatic profile in acromegalic patients to better characterize joint pain. The immunological pattern (rheumatoid factor; antinuclear antibodies—ANA, extractable nuclear antigens—ENA-Ab; anti-citrullinated protein antibodies; erythrocyte sedimentation rate) was evaluated in 20 acromegaly subjects (AS) and 20 control subjects (CS). Bilateral joint ultrasound of hands/wrists and nail capillaroscopy were also performed. Articular pain was more frequent in AS than in CS (p = 0.027). No difference was detected in immunological parameters. ANA and ENA-Ab were positive in only 10% of AS and in 5% of CS, while no difference was found in anti-citrullinated protein antibodies. No difference was detected between rheumatoid factor positivity, but threefold higher IgG were detected in AS compared to CS. The erythrocyte sedimentation rate was significantly higher in AS than CS (p = 0.040), while in AS, there was a trend in increased Power Doppler (PWD) articular uptake. The capillaroscopic evaluation showed a significant difference in almost each parameter (presence and number of tortuous capillaries, capillary enlargements, and hemorrhages), showing a moderate-to-severe microangiopathy in AS. The results of our study suggest that joint damage in acromegaly has not an autoimmune etiology. Increased erythrocyte sedimentation rate levels and PWD alteration in acromegalic population reflect a possible inflammatory nature, while the capillaroscopic findings suggest a moderate-to-severe microangiopathy that could help to identify patients with a greater macroangiopathic risk.

Attention deficit hyperactivity disorder (ADHD) and allergic rhinitis (AR) constitute high-prevalence entities in the pediatric population, and both affect the quality of life of children and their families. Over the last decade, it has been stated that a high number of patients with ADHD show comorbidities with allergic diseases. The aim of this review is to assess the current information about the relationship between both entities. According to some authors, a causal association between them has been proposed since they have genetic, environmental, and inflammatory physiopathological mechanisms in common. However, there is still some controversy on this issue. Sleeping disorders are present in both and should be assessed in patients who suffer these conditions. Therefore, proper treatment of AR and other atopic diseases may be beneficial for the clinical progress of ADHD. Reduction of AR unpleasant symptoms and improvements of sleep quality decrease the child’s irritability, and they may further improve their behavior pattern. Even though this association has not been clearly proven, the allergic conditions and sleep features have to be taken into account in order to improve the patients’ quality of life.

The outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, causing coronavirus disease 2019 (COVID-19), has had a deleterious effect on the delivery of care for all acu...

The management of chronic urticaria (CU) has been controversial. Recently updated international guidelines propose evidence-based diagnosis and treatment. Nevertheless, dermatologists have heterogeneous approaches to managing CU. To estimate the percentage of dermatologists who have an optimal approach to CU according to the international guidelines, and to explore the variables associated with optimal management a cross-sectional study using a 17-question survey was delivered by email to dermatologists from Argentina. Optimal first, second, and third line treatment were considered when dermatologists chose a nonsedative antihistamine; increased the dosage of nonsedative antihistamines, and added omalizumab, respectively. Logistic regression was used to identify variables associated with optimal management. A total of 165 questionnaires were available for analysis. An optimal first, second, and third-line treatment approach was identified in 50%, 35%, and 15% of the dermatologists, respectively. The dermatologists' age being above 55 years old (OR: 0.12, 95% CI: 0.01-0.99, p .005) and having more than 5 years of expertise (OR: 0.4, 95% CI: 0.19-0.81, p .001) were significantly associated with a suboptimal approach in second-line treatment. We could not find variables associated with an optimal first or third-line treatment. The real-life management of CU in Argentina is partly suboptimal according to the international guidelines.

Amoxicillin is a beta-lactam antibiotic commonly indicated in pediatrics and the most frequent cause of drug allergies.To determine the proportion of confirmed amoxicillin allergy in children with diagnostic suspicion seen at the Division of Pediatric Allergy.This descriptive, retrospective study was done between January 2009 and January 2017 in children younger than 18 years with diagnostic suspicion of amoxicillin allergy. The diagnosis was based on questions and specific tests.A total of 234 patients were included; amoxicillin allergy was diagnosed in 10.7 % (95 % confidence interval: 7-15). These patients had a higher prevalence of immediate symptoms (40 % vs. 22 %,Amoxicillin allergy in children referred to specialists was confirmed in 10.7 %.La amoxicilina es un antibiótico betalactámico comúnmente indicado en pediatría y es la causa más frecuente de alergia a medicamentos. Objetivos: Determinar la proporción de alergia confirmada a amoxicilina en niños con sospecha diagnóstica, atendidos en una sección de alergia pediátrica. Población y métodos: Estudio descriptivo retrospectivo entre enero de 2009 y enero de 2017, en menores de 18 años con sospecha diagnóstica de alergia a amoxicilina. Se realizó el diagnóstico según interrogatorio y pruebas específicas. Resultados: Fueron incluidos 234 pacientes; se diagnosticó alergia a la amoxicilina en el 10,7 % (intervalo de confianza del 95 %: 7-15). Estos pacientes tenían mayor prevalencia de síntomas inmediatos (el 40 % vs. el 22 %, p = 0,048) y de exposición previa a betalactámicos (el 84 % vs. el 56 %, p = 0,007). Conclusión: La confirmación de alergia a la amoxicilina en niños derivados a especialistas fue del 10,7 %.

Background Scarce studies address the issue of resource consumption and direct health care costs of patients diagnosed with adult-onset chronic urticaria (CU). Objectives To estimate medical resource consumption and direct health care costs of affected patients in a private health maintenance organization in Buenos Aires, Argentina. Methods Patients diagnosed with adult-onset CU ( International Classification of Diseases, Ninth Revision, Clinical Modification code 708.1, 708.8, or 708.9) and who were members of the Italian Hospital Medical Care Program were included in the study. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. Third-quarter 2014 costs were obtained from the Italian Hospital Medical Care Program and converted into US dollars (using the November 2014 exchange rate). Results A total of 232 patients were included in the study. The mean age at diagnosis was 54.2 ± 20.0 years, and the mean disease duration was 5.4 ± 2.6 years (range, 2–22 years). Of the total number of patients, 75% had allergists as their usual source of care, 23% had dermatologists, 18% had internists, and 3% had rheumatologists. Only 7.8% of the patients had an emergency room admission to manage CU symptoms. To manage the disease, 57.8% of patients used antihistamines and 11.6% used oral corticosteroids. The most relevant source of cost was the medical treatment received, followed by physician visits. The average yearly direct cost per patient was US $1015 ± $752 (95% confidence interval 803–2003). Conclusions This is the first Argentine study that evaluated the costs of CU considering the direct medical costs of the disease. The study provides information on resource utilization and the disease-related economic burden, which is valuable to better understand CU in the local setting. Future research that takes into consideration the direct and indirect costs of the disease will expand knowledge and improve management of the disease.

To report toxicity and efficacy outcome of moderately hypofractionated image-guided external-beam radiotherapy in a large series of patients treated for prostate cancer (PCa). Between 10/2006 and 12/2015, 572 T1-T3N0M0 PCa patients received 70.2 Gy in 26 fractions at 2.7 Gy/fraction: 344 patients (60%) with three-dimensional conformal radiotherapy (3D-CRT) and 228 (40%) with intensity-modulated radiotherapy (IMRT). Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and Houston definition (nadir + 2) were used for toxicity and biochemical failure evaluation, respectively. Median age was 74 years (interquartile range 69-77). Compared with 3D-CRT, in IMRT group more high-risk patients (29% vs 18%; P = 0.002) and more high-volume target (75% vs 60%; P 0.001) were included. Acute gastro-intestinal (GI) toxicity G 1 were registered in 8% and in 11% IMRT and 3D-CRT patients, respectively, whereas late GI G 1 were observed in 2% and 16% IMRT and 3D-CRT patients, respectively. Acute genito-urinary (GU) toxicity G 1 were registered in 26% and 40% IMRT and 3D-CRT patients, respectively, whereas late GU G 1 occurred in 5% IMRT and 15% 3D-CRT patients. Multivariate proportional hazard Cox models confirmed significantly greater risk of late toxicity with 3D-CRT compared to IMRT for GU 1 (P = 0.004) and for GI 1 (P 0.001). With a median 4-year follow-up, overall survival (OS), clinical progression-free survival (cPFS) and biochemical PFS (bPFS) for the whole series were 91%, 92% and 91%, respectively. cPFS and bPFS were significantly different by risk groups. Multivariate Cox models for bPFS and cPFS showed no difference between irradiation techniques and a significant impact of risk group and initial PSA. Moderately hypofractionated radiotherapy is a viable treatment option for localized PCa with excellent tumour control and satisfactory toxicity profile. IMRT seems associated with a reduction in toxicity, whereas tumour control was equal between IMRT and 3D-CRT patients and depended mainly on the risk category.

Since omalizumab has been approved for urticaria, numerous randomized and real-life observational trials have been published. We reviewed the period January 2017–February 2018. Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6–8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse. Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).

Background: In spite of the frequency of chronic urticaria, there are no epidemiological studies on its prevalence in Argentina. Objective: The objective of this study was to define the prevalence and epidemiological characteristics of chronic urticaria patients in Buenos Aires. Methods: The population studied were the members of the Italian Hospital Medical Care Program, a prepaid health maintenance organization located in the urban areas around the Autonomous City of Buenos Aires, Argentina. All patients with diagnosis of chronic urticaria members of the Italian Hospital Medical Care Program, and with at least 12 months of follow up were included in the study. All medical records obtained between January 1st, 2012 and December 31, 2014 were analyzed. The prevalence ratio for chronic urticaria per 100,000 population with 95% CI for December 31, 2014 was calculated. The prevalence rate for the entire population and then discriminated for adults and pediatric patients (less than 18 years old at diagnosis) was assessed. Results: 158,926 members were analyzed. A total of 463 cases of chronic urticaria were identified on prevalence date (68 in pediatrics, 395 in adults), yielding a crude point prevalence ratio of 0.29% (CI 95% 0.26-0.31%). The observed prevalence of chronic urticaria in the adult population was 0.34 % (95% CI 0.31-0.38%), while in pediatrics it was 0.15 % (95% CI 0.11-0.20%). Study limitations: the main weakness is that the results were obtained from an HMO and therefore the possibility of selection bias. Conclusions: chronic urticaria is a global condition. Its prevalence in Buenos Aires is comparable with other countries.

Latex allergy is common in the hospital setting.To describe the clinical situation of three pediatric interns with latex allergy and the prevention strategies implemented during clinical clerkships in pediatric and neonatal intensive care units.The three interns referred symptom exacerbation during their internship program. Diagnosis was confirmed based on a compatible history and positive specific immunoglobulin E. A semi-structured interview was done to describe perceptions about prevention strategies, the personnel were trained, and nitrile gloves were provided for carrying out procedures. Interns completed their clinical clerkships without having allergic reactions. Positive aspects referred by interns were that they felt cared for and experienced an improved quality of life; negative aspects were a bad predisposition and resistance against change among some other interns. Strategies designed to this end permitted interns to continue their internship program.La alergia al látex es frecuente en ámbitos hospitalarios.Describir la situación clínica de tres residentes de Pediatría con alergia al látex y las estrategias de prevención en las rotaciones de Terapia Intensiva Pediátrica y Neonatal.Las tres profesionales manifestaron exacerbación de síntomas durante la residencia. Se confirmó el diagnóstico con historia compatible e inmunoglobulina E específica positiva. Se realizó una entrevista semiestructurada para describir sus percepciones en relación con las estrategias de prevención, se capacitó al personal y se incorporaron guantes de nitrilo para los procedimientos. Las residentes realizaron las rotaciones sin presentar manifestaciones alérgicas. Refirieron como aspectos positivos sentirse cuidadas y mejor calidad de vida; como aspectos negativos, mala predisposición y resistencia al cambio en algunos compañeros. Las estrategias diseñadas permitieron que las residentes pudieran continuar su programa de formación.

Cow's milk protein allergy (CMPA) is the most common food allergy in pediatrics. In Argentina, the prevalence of this disease has been evaluated in a few trials.To estimate the prevalence of CMPA and describe its variation throughout a period of 11 years.A retrospective cohort study was carried out in live newborn infants enrolled in a health care program of a university community hospital.One hundred and sixteen cases of children with CMPA were identified. Cumulative prevalence was 0.8% (95% confidence interval [CI]: 0.65-0.95). A percent increase of 0.4% in 2004 to 1.2% in 2014 was observed in the number of cases per year.In 2014, CMPA prevalence was 1.2%, i.e. three times that of 2004.La alergia a la proteína de la leche de vaca (APLV) es la alergia alimentaria más frecuente en pediatría. Existen pocos estudios que han evaluado la prevalencia de esta enfermedad en Argentina. Objetivos. Estimar la prevalencia de la APLV y describir su variación durante un período de 11 años. Pacientes y métodos. Se realizó un estudio de cohorte retrospectivo en recién nacidos vivos pertenecientes al programa de atención médica de un hospital universitario de comunidad. Resultados. Se identificaron 116 casos de niños con APLV. La prevalencia acumulada fue de 0,8% (intervalo de confianza –IC– 95%: 0,65-0,95). Se observó un incremento porcentual de casos por año, de 0,4% en 2004 a 1,2% en 2014. Conclusión. La prevalencia de APLV fue del 1,2% en 2014, tres veces superior a la prevalencia en 2004.

The two phenotypes of both limited and diffuse systemic sclerosis (SSc) have different forms of pulmonary involvement: pulmonary arterial hypertension (limited phenotype) or interstitial lung disease (ILD) (diffuse phenotype). We aimed to investigate whether Th17-related cytokines, as measured in exhaled breath condensate (EBC) and in serum were connected to ILD in diffuse SSc patients. We found that for both limited and diffuse SSc, the EBC levels of all cytokines and most of the cytokine serum levels were significantly higher in patients than in controls, while, the EBC levels of Th-17 cytokines and the serum levels of IL-10 and TNF-α were significantly higher in diffuse than in limited SSc. Moreover, the thoracic CT-scan score of ILD was significantly associated with the EBC levels of IL-1 beta and with the serum IL-23, TNF-α and IL-10 levels, whereas lung carbon monoxide diffusing capacity was negatively related to the EBC levels of IL-1 beta, IL-17 and serum IL-10. Serum IL-23 was also inversely correlated with vital capacity. In conclusion, in diffuse SSc patients our results show a clear link between Th-17 cytokines measured both in EBC and in serum with interstitial lung involvement. This highlights how important it is to target Th-17 cytokines when developing new treatments for lung fibrosis.

Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce.To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors.Descriptive, cross-sectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact with latex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit.Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ± 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures.According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos.Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados.Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada.Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas.El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.

Resistance risk assessment, analysis of resistance events and risk management are based on elements such as the mode of resistance in target organisms, similarity of inhibitors, detection methods for resistant individuals, and design and validation of product use strategies. The mode of resistance may be analysed in several steps including the molecular, genetic, biochemical, physiological, and population level. Historical and recent findings are described for phenylamide fungicides (PAFs), demethylation inhibitors (DMIs) in sterol biosynthesis and fungicides of the strobilurin-type action and resistance (STAR) group (Qo respiration inhibitors, QoIs) with regard to the site of resistance in target pathogens and the presence of resistant individuals in populations.

Top of pageAbstract Objective To evaluate the functional changes after treatment of paediatric optic pathway gliomas (OPGs). Methods All patients with monofocal OPG seen from January 2004 to January 2011 were included. Best corrected visual acuity (BCVA, LogMAR), contrast sensitivity (Hiding-Heidi low-contrast ‘face’ test (HH) and Pelli−Robson (PR) contrast sensitivity test), and the Color Test (Ishihara plate) were obtained. Results Twenty-one patients (10 boys and 11 girls with a mean age of 5.5±4.4 years at diagnosis) were included in the study. Neurofibromatosis was present in four cases. Eighteen patients (85.7%) were treated with initial surgery and three patients (14.3%) with initial chemotherapy. BCVA was 0.67±0.8 LogMAR at baseline and 0.62±0.9 LogMAR at last visit (P=0.41). The Color test was not significantly changed at last visit (P=0.62). Contrast sensitivity with the HH test was 9.1±11.1% at baseline and 3.8±6.4% at last visit (P=0.03). Contrast sensitivity with PR chart was 1.33±0.9log at baseline and 1.05±0.7 log at last visit (P=0.005). A reduction in contrast sensitivity at both tests was significantly greater in patients who relapsed than in patients who did not relapse (P=0.001). Conclusion After the treatment of paediatric optic pathway low-grade gliomas, a reduction in contrast sensitivity during follow-up was observed and may be correlated with tumour relapses. Keywords: Low-grade gliomas; astrocytoma; contrast sensitivity; relapse

Large gaps in care quality resulting from ineffective communication between health providers, patients, and other health care organizations have been documented. Research suggests that effective, empathic communication positively influences health outcomes. Many studies focused on the assessment of clinicians empathy, while there is still a lack of evidence on the role and level of empathy for public health medical doctors,especially during their postgraduate education. The aim of this study was to assess empathy level of public health residents, and to investigate differences in empathy scores using a validated questionnaire. The Italian version of the Jefferson scale of Physician Empathy was mailed to all the resident doctors of the Italian Schools in Hygiene and Public Health during the month of April 2013. Individual Empathy Scores (IES) were calculated, as well as descriptive statistics for the items and scale levels. The difference in empathy scores according to physician’s gender, age class, career rank, place of residency, work experiences(medical direction vs research career) were examined trough t test or ANOVA as appropriate. 352 out of 402 resident doctors replied the questionnaire(response rate 87%). The mean of IES was 118.5 (SD 13.4; range = 54-140; median = 120). There were no IES differences between career rank (p = 0.3), age class (p = 0.2), and place of residency (p = 0.07), while females had higher IES than males (120.3 vs 114.9; p < 0.01). Physicians who have had experience in healthcare administration reported higher IES compared to those who only performed research activity (120.4 vs 117.1; p = 0.02). In addition the respondent physicians believe that the development of social skills should be promoted with greater attention during the undergraduate education (78%)and during the postgraduate education in public health (65%). Our results show a good level of IES in the public health residents, with some significant differences according to gender and physicians work experience. Furthermore, considering empathy and cultural competence essential for public health professionals in order to provide and manage high quality patient-centred care, the widespread demand for specific training outlined by this survey should be taken into adequate account.

Background: The Sabin vaccine is used worldwide, and most children with food allergies receive it without incident. However, in the 2009 vaccination campaign conducted in Argentina, four children experienced immediate-type hypersensitivity reactions following vaccination. Objective: We aimed to review the medical history of the affected children, study their allergic condition after the episodes and analyse the presence of allergenic vaccine components. Methods: Patients were selected based on their immediate allergic reactions following vaccination. They were assessed for allergies to cow’s milk and hen’s egg. The presence of cow’s milk proteins in the vaccine was tested by various immunoassays involving cow’s milk- or α-lactalbumin-specific polyclonal rabbit antiserum, and patient sera. Results: All of the patients had a history of milk allergy, and no history or current evidence of egg hypersensitivity was found. Levels of cow’s milk- and Sabin vaccinespecific IgE were increased, and the result of a skin prick test with cow’s milk proteins or the Sabin vaccine was positive in each patient. In addition, an ELISA using specific rabbit antiserum detected α-lactalbumin in the Sabin vaccine. When α-lactalbumin was employed as a soluble inhibitor in a competitive ELISA, binding to vaccine-coated plates by cow’s milk- or α-lactalbumin-specific rabbit antiserum or by patient serum containing IgE was inhibited. Conclusions: We have demonstrated that these patients were allergic to cow’s milk, and had circulating and mast cell-bound IgE antibodies specific to cow’s milk proteins. We found that the Sabin vaccine contained α-lactalbumin, which may have been responsible for the reactions elicited following vaccination with the Sabin and dual viral vaccines in combination. Fil: Parisi, Claudio Alberto Salvador. Hospital Italiano de Buenos Aires; Argentina Fil: Smaldini, Paola Lorena. Universidad Nacional de la Plata. Facultad de Cs.exactas. Departamento de Ciencias Biologicas. Laboratorio de Investigaciones del Sistema Inmune; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Gervasoni, Maria Eugenia. Hospital de Niños Víctor J, Vilela. Servicio de Alergia e Inmunología; Argentina Fil: Maspero, Jorge Fernando. Fundación CIDEA; Argentina Fil: Docena, Guillermo H.. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de la Plata. Facultad de Cs.exactas. Departamento de Ciencias Biologicas. Laboratorio de Investigaciones del Sistema Inmune; Argentina

SUMMARY The clinical results of AML patients, especially if elderly, are particularly dismal, although the achievement of CR with MRD after combined chemotherapy appears as possible in a good fraction of patients. Indeed, the persistence of MRD leads to progression and patients ultimately die. For these reasons, alternative approaches for the prevention of relapse in CR patients are necessary and are currently under active investigation. Allogeneic stem cell transplantation (SCT), which combines the cytotoxic effect of conditioning regimen with adoptive immunotherapy, has been shown to offer a clear advantage in terms of relapse prevention, thus providing the proof-of-principle of the capacity of immune cells of eradicating MRD. However, such approach has several and important limitations and is not applicable to all the patients, especially if elderly. In this scenario, the role of immunological therapies in the post-remission management of adult AML patients, such as NK therapy, beside the SCT setting, have been recently exploited with promising results in terms of immunological and clinical responses.

The aim was to measure the loudness of monaural and binaural stimuli in a group of cochlear implant users who had residual hearing in the nonimplanted ear, and to consider the implications of these measures for a binaural fitting consisting of a hearing aid and an implant in opposite ears. Three independent hypotheses were addressed: that the shapes of the electric and acoustic loudness growth functions would be similar, although the dynamic ranges would differ; that standard implant and hearing aid fittings would result in substantial loudness mismatches between the acoustic and electric signals; and that loudness summation would occur for binaural combinations of electric and acoustic signals.A modified version of the "Loudness Growth in 1/2-Octave Bands" method (Allen, Hall,Jeng, 1990) was used to measure loudness growth for each ear of nine subjects. At the time of the experiment, the subject group included all implant users in Melbourne and Denver who were available for research and who also had sufficient residual hearing to use a hearing aid in the nonimplanted ear. Five acoustic frequencies and five electrodes were measured for each subject. The same subjects also estimated the loudness of a set of stimuli including monaural and binaural signals chosen to cover the loudness range from very soft to loud.The shapes of the averaged loudness growth functions were similar in impaired and electrically stimulated ears, although the shapes of iso-loudness curves were quite different in the two ears, and dynamic ranges varied considerably. Calculations based on the psychophysical data demonstrated that standard fitting procedures for cochlear implants and hearing aids lead to a complex pattern of loudness differences between the ears. A substantial amount of loudness summation was observed for the binaural stimuli, with most summation occurring when the acoustic and electric components were of equal loudness. This is consistent with observations for subjects with normal hearing and subjects with bilaterally impaired hearing.These experiments provide data on which criteria and methods for the binaural fitting of cochlear implants and hearing aids may be based. It is unlikely that standard monaural fitting methods for cochlear implants and hearing aids will result in balanced loudness between the two ears across a reasonably broad range of frequencies and levels. It is also likely that output levels of both devices will need to be reduced relative to a monaural fitting to compensate for the binaural summation of loudness in some listeners.

The specific physical and chemical characteristics of supercritical solvents and solvent mixtures that can affect the yield and the properties of coal extracts were experimentally investigated. Strong non-ideal interactions, such as polar bonding and hydrogen transfer, as well as synergistic interactions in multicomponent solvent mixtures, were shown to produce large deviations from the simple, density-driven supercritical solubility. These interactions can be manipulated to optimize supercritical coal extraction by reducing the severity of the extraction conditions (pressure in particular). Physical and chemical changes occurring in the coal structure during supercritical solvent extraction were also examined. 10 references, 5 figures, 9 tables.

In several bone disorders, including those with metastatic involvement, changes in procollagen type I C-terminal and type III N-terminal peptides are detected, as indications of altered bone metabolism. Assessment of bone turnover could play a role in the evaluation of response to Strontium-89 used as palliative treatment in symptomatic bone metastases from various primary tumors. A correlation between bone formation rate markers procollagen I and III and efficacy of ionic Strontium-89 was shown in a group of 13 patients who underwent treatment with 4 mCi of Strontium-89 for painful bone metastases: 5 from breast, 7 from prostate, and 1 from lung carcinoid cancer. Assessed as a modification of analgesic intake, pain, and ambulation, there were 6 complete remissions, 3 partial remissions, and 4 nonresponders. The duration of the response was from 2 to 11 months. Procollagen I and III levels were found to be highly abnormal in those with no benefit from Strontium-89 administration but were in the normal range or only slightly elevated in those achieving complete or partial pain control, thus correlating with the clinical response.

Abstract 4250 Background. Nelarabine (N) is approved for the treatment of T-ALL and T-LBL that have not responded to or has relapsed after treatment with at least 2 chemotherapy regimens. Aim. To evaluate safety profile and efficacy of N as savage therapy in 16 adult relapsed or refractory T-ALL or T-LBL. Methods. After obtaining an informed consent, 16 patients (median age 33 years, range 19–45, M/F= 13/3) affected by T-ALL (n=10) and T-LBL (n=6) received savage therapy with N (median cycle=1, range 1–3), administered at standard adult dosage (1500 mg/sqm on days 1, 3 and 5, every 21). Four patients were primary resistant to induction treatment, 7 patients were relapsed after two previous chemotherapy regimens (including allogeneic BMT in 4 cases and autologous SCT in 1 case); the remaining 6 patients had a molecular relapsed disease (MRD positive). Molecular characterization was performed, including NOTCH and WT-1 genes mutational status. GEP analysis, according to Ferrando A. stratification (Cancer Cell 2002), is still ongoing. Results. Currently, 12 out of 16 patients are evaluable, due to a too short follow up in the other 4 cases. Seven out of 12 patients obtained a complete remission (CR) (5 T-ALL 2 T-LBL);a partial remission (PR) was documented in 2 cases, with an overall response rate (ORR) of 75%. Median duration of CR was 10 weeks (range 2.8–54+). Among these, 2 out of 4 patients in molecular relapse reached a molecular CR and underwent an allogenic BMT (currently in CR after a median follow up of 12 months). Extra- hematological toxicity, not clearly related to the drug, occurred in 3 cases, determining, a complete and irreversible paraplegia, a condition of mental confusion, and a peripheral neuropathy, respectively. Conclusions. N showed a strong efficacy also in cases with low levels of residual disease, in addition to a good safety profile. Neurological toxicity needs to be strictly monitored. Acknowledgments. European LeukemiaNet, AIL, AIRC, Fondazione Del Monte di Bologna e Ravenna, FIRB 2006, PRIN 2008, PRIN 2009, Ateneo RFO grants, Project of integrated program (PIO), Programma di Ricerca Regione – Università 2007 – 2009. Disclosures: Baccarani: Novartis: Consultancy, Honoraria; BMS: Consultancy, Honoraria. Martinelli:Pfizer: Consultancy; BMS: Consultancy, Honoraria; Novartis: Consultancy, Honoraria.

Abstract 3580 Introduction: Although treatment with tyrosine kinase inhibitors (TKIs) has revolutionized the management of adult patients with BCR-ABL1 -positive acute lymphoblastic leukemia (ALL) and significantly improved response rates, relapse is still an expected and early event in the majority of them. It is usually attributed to the emergence of resistant clones with mutations in BCR-ABL1 kinase domain or to BCR-ABL1 -independent pathways but many questions remain unresolved about the genetic abnormalities responsible for relapse after TKI and chemotherapy-based regimens. Patients and methods: In an attempt to better understand the genetic mechanisms responsible for this phenomenon, we have analyzed matched diagnosis-relapse samples from 30 adult BCR-ABL1 -positive ALL patients using high resolution Affymetrix single nucleotide polymorphism (SNP) arrays (GeneChip® Human Mapping 250K NspI, n=15 pairs and Genome-Wide Human SNP 6.0, n= 15 pairs). Genetic differences were analyzed in terms of copy number changes and loss of heterozygosity (LOH) events. 20 patients were enrolled in clinical trials of GIMEMA AL Working Party and treated with imatinib alone or in combination with conventional chemotherapy (40%) or dasatinib as frontline therapy (60%). The median age at diagnosis was 54 years (range 23–74) and the median blast cell count was 97% (range 60–99). The median time to relapse was 27 months (range, 9–104). 10 patients were treated according to the GMALL trials, a high-dose chemotherapy based protocol in combination with imatinib. The median age at diagnosis was 65 years (range 19–79) and the median leucocyte count was 37300/μl (range 5000 – 220000/μl). The median time to relapse was 9.8 months (range, 3 – 25). Results: First, we compared diagnosis and relapse samples for the presence of macroscopic (> 1.5 MB) copy number alterations (CNA). Novel acquired macroscopic CNAs were detected in 7/20 (35%) TKI relapse cases and included losses of 3p12-p14, 5q34, 9q34, 10q24 and 12p13-p12 and gains of 1q, 9q34-q33 and 22q and in 4/10 (40%) chemotherapy-relapse cases and included losses of 9p21 and 12q21–22 and gains of all chromosome 8 or part of it in 2 patients. Since no common patterns of acquired alterations were observed, it is likely that relapse may be due to a more generalized genetic instability rather than to specific mechanisms. Moreover, chemotherapy did not select resistant clones with higher number of alterations. 8/20 (40%) TKI resistant cases and 4/10 chemotherapy resistant patients harbored the same CNAs present in the matched diagnosis sample (losses of 9p21 in 7 cases, 7p and 22q11 in single cases and gains of chromosomes 1q, 4, 8q, 17q and 21), indicating a common clonal origin. In contrast, in 5/20 (25%) TKI resistant cases and 4/10 (40%) chemotherapy resistant patients macroscopic CNAs present at diagnosis were lost at relapse (losses of chromosomes 7, 11q, 14q, 15q, 16q and 19p and gains of 5q, 8q, 9q34 and 22q11). Thereafter, we compared diagnosis and relapse samples for microscopic CNAs (< 1.5 MB). The alteration most frequently acquired at relapse was loss of the tumor suppressor CDKN2A (53% vs 33 % of diagnosis). Other common acquired CNAs at relapse included gains of ABC transporter genes, such as ABCC1, ABCC6 (1q41) and BCL8 (15q11); losses affected EBF1 (5q33) and IGLL3 (22q11) genes involved in B-cell development, BTG1 (12q21) involved in cell cycle regulation and CHEK2 (22q12) involved in DNA repair. Interestingly, for all relapse cases analysis of IKZF1 deletions, identified in 80% of patients, demonstrated a clonal relationship between diagnostic and relapse samples, suggesting that this alteration is not acquired with relapse but it is maintained with fidelity from diagnosis working as a marker of disease. The majority (92%) of relapse samples harbored at least some of the CNAs present in the matched diagnosis sample, indicating a common clonal origin. Conclusions: Genomic copy number changes evolving from diagnosis to relapse have been identified demonstrating that a diversity of alterations contributes to relapse and with the most common alterations targeting key regulators of tumor suppression, cell cycle control, and lymphoid/B cell development. Supported by European LeukemiaNet, AIL, AIRC, Fondazione Del Monte di Bologna e Ravenna, FIRB 2006, PRIN 2009, Ateneo RFO grants, PIO program, Programma di Ricerca Regione – Università 2007 – 2009. Disclosures: Soverini: Novartis: Consultancy; ARIAD: Consultancy; Bristol-Myers Squibb: Consultancy. Baccarani:Pfizer Oncology: Consultancy; Novartis: Consultancy; BMS: Consultancy; Ariad: Consultancy; Novartis: Research Funding; Pfizer Oncology: Honoraria; Novartis: Honoraria; BMS: Honoraria; Ariad: Honoraria; Novartis: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Ariad: Membership on an entity's Board of Directors or advisory committees. Ottmann:Novartis Corporation: Consultancy, Honoraria, Research Funding, Speakers Bureau. Martinelli:Novartis: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Pfizer: Consultancy.