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We aimed to compare visual and anatomical outcome in subretinal aflibercept vs. intravitreal aflibercept in the context of Pars Plana Vitrectomy (PPV), pneumatic displacement with subretinal air and subretinal tPA in patients with naïve submacular haemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD).Retrospective interventional cohort study.80 patients treated with subretinal aflibercept vs. intravitreal aflibercept in the context of PPV, subretinal air and subretinal tPA in patients with SMH secondary to naïve nAMD.Records were reviewed. Best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) were recorded at baseline and 24 months after treatment.BCVA, CST, and number of anti VEGF treatment over follow-up period.The average duration from onset of symptoms to surgery was 1.26 days (range 0-3 days). Based on review of OCT images, SMH was subretinal in all 80 patients (100%), and sub-RPE in 29 patients (36.3%). Forty-one patients (51.25%) were treated with subretinal aflibercept ("subretinal group"), and 39 patients (48.75%) were treated with intravitreal aflibercept injections ("intravitreal group"). The groups were well balanced for age and gender p = 0.6588, and p = 0.263, respectively). Both groups showed statistically significant improvement in BCVA and CST (for all groups: p 0.001). The mean number of anti VEGF given during follow-up period was statistically significantly lower in the "subretinal group" (p 0.0001).This study shows better management of the CNV, with a statistically significant lower need for anti-VEGF injections when treated with subretinal aflibercept compared to intravitreal application.

Resumen Objetivo Describir la frecuencia del anticuerpo anti-RNA polimerasa III positivo en pacientes con esclerosis sistemica (ES) de un grupo de centros asistenciales de Argentina, y explorar las diferencias entre pacientes con anti-RNA polimerasa III positivo y negativo. Pacientes y metodos Se recopilaron datos de las historias clinicas, anamnesis y examenes fisicos de 135 pacientes con ES (ACR/EULAR 2013), de los cuales se obtuvo una muestra de suero para la deteccion de anti-RNA polimerasa III IgG por ELISA. Resultados El 92,6% fueron mujeres, la mediana de edad al diagnostico fue de 53 anos (rango: 12-87), el 77,7% tenia ES limitada, el 19,3% tenia ES difusa y el 2,9% con ES sine esclerodermia. El 67,5% de los pacientes pertenecian a la etnia mestiza o amerindia. La frecuencia de anti-RNA polimerasa III positivo fue del 5,9%. En 36 pacientes los anticuerpos anticentromero (ACA) y anti-Scl70 fueron negativos; el anti-RNA polimerasa III fue positivo en el 16,7% de estos 36 pacientes. El grupo de pacientes con anti-RNA polimerasa III positivo tuvo una mayor frecuencia de cicatrices puntiformes e hipertension arterial pulmonar, y una mayor edad al diagnostico. No se encontro asociacion con ectasia vascular gastrica antral. La unica paciente con crisis renal esclerodermica, fue anti-RNA polimerasa III positiva. Conclusiones La frecuencia de anti-RNA polimerasa III encontrada en este estudio fue una de las mas bajas reportadas, lo cual podria estar relacionado con el predominio de la etnia mestiza y amerindia. Si bien se necesitan mas estudios, es posible que la deteccion del anti-RNA polimerasa III permita clasificar mejor a los pacientes con ES, conocer su pronostico y mejorar el seguimiento.

ANCA-associated vasculitis is a heterogeneous group of rare autoimmune conditions of unknown cause. Clinical characteristics and prognostic factors were analyzed in 47 patients: 20 (42.5%) with granulomatosis with polyangiitis, 17 (36.2%) with microscopic polyangiitis, 6 (12.8%) with renal-limited vasculitis, and 4 (8.5%) with eosinophilic granulomatosis with polyangiitis. Mean age at diagnosis was 53.5 ± 16.5 years and the median of BVAS (Birmingham Vasculitis Activity Score) was 14 (4-42). The most frequent clinical manifestations were: general in 44 (93.6%), renal in 30 (63.8%) and respiratory in 28 (59.6%). All received corticosteroids at the beginning of treatment. Intravenous cyclophosphamide was associated in 20 (42.5%) and oral route in 14 (29.8%); azathioprine in 3 (6.4%) and rituximab in 2 (4.2%). At a median follow-up of 35.5 months (range 0.14-234), 21 relapses were recorded in 14 patients. Overall mortality was 3.5 deaths per 100 patient-year in the whole group. Those over 55 years old, the presence of alveolar hemorrhage, those with FFS (Five Factor Score) of 2, and patients with MPA had poor prognosis. Renal involvement, ANCA pattern and BVAS were not associated to a poorer prognosis.Las vasculitis asociadas a ANCA son un grupo heterogéneo de entidades autoinmunes, poco frecuentes, de etiología desconocida. Analizamos las características clínicas y factores pronóstico en 47 pacientes: 20 (42.5%) granulomatosis con poliangeítis, 17 (36.2%) poliangeítis microscópica, 6 (12.8%) vasculitis limitada al riñón y 4 (8.5%) granulomatosis eosinofílica con poliangeítis. La edad promedio al diagnóstico fue 53.5 ± 16.5 años y la mediana de BVAS (Birmingham Vasculitis Activity Score) 14 (4-42). Las manifestaciones clínicas más frecuentes fueron: generales en 44 (93.6%), renales 30 (63.8%) y respiratorias en 28 (59.6%). Todos recibieron corticoides al inicio del tratamiento. Se asoció ciclofosfamida endovenosa en 20 (42.5%) y oral en 14 (29.8%); azatioprina en 3 (6.4%) y rituximab en 2 (4.2%). En una mediana de seguimiento de 35.5 meses (rango 0.14-234), se registraron 21 recaídas en 14 pacientes. La mortalidad fue 3.5 por cien pacientes-año en todo el grupo. Los mayores de 55 años, con presencia de hemorragia alveolar, FFS (Five Factor Score) de 2, y los casos con poliangeítis microscópica tuvieron peor pronóstico. El compromiso renal, el patrón de ANCA y el BVAS no se asociaron a peor pronóstico.

Medical attention is not free from committing mistakes that can increase mortality and costs. The International Goals for Patient Safety include correct patient identification. The use of wristbands reduces the number of adverse events. The rate of nonidentified patients at the moment of phlebotomy was investigated retrospectively during 2019. The annual rate of non-identified patients was 9.8% and higher rates were observed from April to September. Monday was the day with the highest rate of non-identified. There was statistically significant relationship between the month rate of non-identified patients and the number of discharges from operative unit per month (r=0.6465; p=0.0237) and the bed turnover rate (r=0.7776; p=0.0029). Other wristband identification errors are unknown. The investigation detected failures in patient identification that allowed to make recommendations. In order to reduce the number of missing wristbands it will be necessary to monitor the indicator, especially during the months with the highest number of discharges and bed turnover rate, to evaluate the adherence of the personnel to the current protocol and to carry out training programs.La atención médica no se encuentra libre de errores, que pueden poner en riesgo tanto la salud como la vida de los pacientes, con aumento de la morbimortalidad y los costos del sistema sanitario. Las recomendaciones internacionales de seguridad del paciente incluyen una correcta identificación. El uso de pulseras identificatorias reduce la cantidad de eventos adversos. Se investigó en forma retrospectiva la tasa de pacientes sin pulsera identificatoria al momento de la extracción sanguínea durante el año 2019 en el Instituto de Investigaciones Médicas Alfredo Lanari (IDIM). Se registró un total de 521 casos de pacientes no identificados sobre 5267 pedidos de laboratorio. La tasa anual de no identificados fue de 9.8%, superior al máximo ac eptable, y entre abril a septiembre se observaron mayores valores promedio. El día de la semana con mayor tasa de no identificados fueron los lunes con un 14%. Se observó una relación estadísticamente significativa entre la tasa mensual de no identificados con la cantidad mensual de egresos d e unidades operativas (r = 0.6465; p = 0.0237) y con el giro cama (r = 0.7776; p = 0.0029). Se desconoce si hubo otros errores de identificación. El estudio permitió conocer fallas en la identificación de pacientes internados. Se recomienda monitorear el indicador especialmente durante los meses con mayor cantidad de egresos y giro cama, evaluar la adherencia del personal al protocolo vigente y realizar capacitaciones para lograr una menor tasa de no identificados.

Introducción: El sindrome de Apneas Hipopneas Obstructivas del sueño (SAHOS) es una patología con una prevalencia en aumento que produce un impacto significativo en la calidad de vida y en la morbimortalidad, fundamentalmente cardiovascular. Objetivos: Describir síntomas, comorbilidades y medidas antropométricas de pacientes evaluados clínicamente y sometidos a estudios de sueño para identificar variables que se asocian a un Índice de Perturbación Respiratoria (IPR) mayor o igual a 15. Material y métodos: Se revisaron cuestionarios autoadministrados, antropometría, comorbilidades y estudios de sueño de los pacientes que consultaron por primera vez en el consultorio de patología respiratoria del sueño entre junio de 2012 y mayo de 2016. Resultados: Entre los 366 pacientes incluidos se encontró 47.5% con IPR>30, 21,9% con IPR 15–29.9, 22,1% con IPR 5–14.9 y 8.5% con IPR

Objetivos: comparar la tasa de erradicacion de Helicobacter pylori (H. pylori) y de seguridad entre un esquema cuadruple concomitante ajustado al peso corporal con el mismo esquema a dosis fijas en pacientes obesos precirugia bariatrica. Metodos: estudio prospectivo que incluyo 104 pacientes obesos. Resultados: la erradicacion por intencion de tratar fue del 86,3 % (IC 95 %: 74,3-93,2) en el grupo ajustado al peso corporal y del 66,1 % (IC 95 %: 52,6-77,3) en el grupo a dosis fijas. Se hallaron un valor p < 0,05 y un riesgo relativo (RR) de 1,31 (IC 95 %: 1,05-1,63). Las discontinuaciones y los eventos adversos fueron similares. Conclusion: un esquema individualizado al peso corporal parece ser superior que uno a dosis fijas en pacientes obesos.

Background and study aims The main concern about endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy is the risk of radiation exposure to the fetus. The potential exists not only in the short-term, but also in the long-term and includes growth and development problems and the possibility of childhood cancer. Little is known about the long-term effects of fetal radiation exposure at the time of ERCP. The aim of the study was to report the long-term outcome of babies born after radiation exposure to mothers who underwent ERCP during pregnancy. Patients and methods This was a single-center retrospective cohort study. We included 24 consecutive pregnant patients who underwent ERCP due to choledocholithiasis and their children, between June 1997 and June 2015. All patients and their babies were followed up until birth to assess their short-term outcome. To assess long-term outcomes, from September 2014 to September 2015, a comprehensive medical interview was conducted with the mothers and their children. We also evaluated medical records, lab tests, school report cards, and the families completed a questionnaire inquiring about perceived health status of the children. Results Fifteen patients had full-term pregnancies. One patient had a preterm delivery (32 weeks) due to preeclampsia. There were no cases of miscarriage, stillbirth or fetal malformations. Long-term follow-up was performed at a mean age of 11.08 years (range 1–18) for the children, with no developmental delays, poor school performance, or malignancies found. Conclusions Long-term outcome in children born after radiation exposure during ERCP was unremarkable.

The aim of the study was to describe the clinical characteristics and the proportion of the different etiologies of liver cirrhosis (LC) diagnosed between 2010 and 2017 and compare with the period 1995-2002. In the 2010-2017 period, 260 patients with LC were diagnosed. The etiologies were: Alcohol 94 patients (36.1%), chronic hepatitis C (HCV) 87 (33.4%), non-alcoholic fatty liver disease (NAFLD) 35 (13.4%), primary biliary cholangitis 13 (PBC) (5.0%), autoimmune hepatitis (AIH) 12 (4.6%), chronic hepatitis B 7 (2.7%), hereditary hemochromatosis 1 (0.4%) and cryptogenic 11 (4.2%). Compared with the 1995-2002 period that included 252 patients, there was a significant reduction in the number and percentage of LC by alcohol and cryptogenic and an increase in those associated with NAFLD and AIH. In comparison with the period 1995-2002, a better hepatic function of LC was observed in general, and especially in those related to alcohol and HCV. However, in the 2010-2017 period, LC by alcohol compared with those associated with HCV and NAFLD showed a significantly greater deterioration in liver function. The main etiologies of LC are alcohol and HCV followed by NAFLD and autoimmune liver diseases (PBC and AIH). Although in the current period LC was diagnosed at earlier stages, LC by alcohol presented a low percentage of initial diagnoses in the asymptomatic stage.

Peripheral blood mononuclear cells (PBMC) from patients with ocular toxoplasmosis were challenged with total antigens from Toxoplasma gondii lysate (TATL) in a cytokine release assay (CRA), run during the inactive period of the disease. Increased interferon gamma (IFN-γ) levels were detected after PBMC stimulation with either ME49 reference strain (P = 0.0015) or local TgCkAr-11-9 isolate (P = 0.0012), as compared with those recorded under basal conditions. TATL from TgCkAr11-9 isolate induced a higher release of IFN-γ than ME49 strain in CRA from all tested patients (P = 0.02). The median value of IFN-γ release on TgCkAr-11-9 stimulation (26.03 pg/mL) allowed the classification of patients into high- or low-/non-IFN-γ releasers. Clinical correlations were established with both groups. The results obtained in this study suggest the need to include local strains when performing CRA with TATL., Facultad de Ciencias Veterinarias

Since 1996, the Hospital del Tórax Dr. Antonio A. Centrángolo conducts a pulmonary rehabilitation program that requires patients with chronic pulmonary disease to attend the hospital twice a week. In 2015 the home-based program (HBP) was developed for patients living more than either 10 km or 60 minutes away from the hospital, or with conflicting working schedules. A retrospective study was conducted to describe the adherence to the home-based program by patients with chronic pulmonary disease, and explore adherence-related factors. In 2017, 96 (75.6%) of 127 patients eligible for pulmonary rehabilitation were assigned to the home-based program; they were instructed to complete at least three exercise sessions a week -including aerobic and resistance, segmental strength of upper and lower limbs, and flexibility-; and attend hospital visits every 20 to 30 days; "adherence to the HBP" was determined for patients who attended their final assessment on the fifth visit. A 40.6% (n = 39) of the patients only attended the first visit; 23% (n = 22) adhered to the program. This latter group of patients had shown, at their first assessment, better FVCs (p = 0.013), lower dyspnea scores (p = 0.008), and less than two or more exacerbations during the previous 6 months (p = 0.032). Only one patient needed to take three or more different transportation services to reach the hospital (p = 0.006). The results suggest that adherence to the home-based program was associated to a better clinical status and better access to the hospital.Desde 1996, el Hospital del Tórax Dr. Antonio A. Cetrángolo aplica un programa de rehabilitación respiratoria, el cual requiere la concurrencia al hospital, dos veces por semana, de los pacientes con enfermedad respiratoria crónica. En 2015, se desarrolló el programa domiciliario (PD) para pacientes que viven a más de 10 km del hospital, o necesitan más de 60 minutos de viaje, o trabajan y tienen incompatibilidad de horarios con el programa hospitalario. Se realizó un estudio retrospectivo con el objetivo de describir la adherencia al programa domiciliario de pacientes con enfermedad respiratoria crónica y explorar los factores relacionados. En 2017, 96 de 127 (75.6%) pacientes elegibles para rehabilitación respiratoria fueron asignados al programa domiciliario y se les indicó cumplimentar al menos tres sesiones semanales de ejercicios de resistencia aeróbica, fuerza segmentaria de miembros superiores e inferiores y flexibilidad; y concurrir al hospital cada 20 o 30 días; a la quinta visita se realizó la reevaluación. Se consideró "adherencia al PD " cuando el paciente completaba la misma. El 40.6% (n = 39) solo asistió a la evaluación inicial y un 23% (n = 22) adhirió al programa. El grupo adherente presentó, al inicio, mejor FVC (p = 0.013), menor score de disnea (p = 0.008), menos de dos o más exacerbaciones en los seis meses previos (p = 0.032). Un solo paciente necesitaba tres o más transportes para llegar al hospital (p = 0.006). Los resultados sugieren que la adherencia al programa domiciliario se relacionó con mejor situación clínica y mejor accesibilidad a la institución.

Many bariatric surgeons recommend routine Helicobacter pylori (H. pylori) screening as a part of the workup for bariatric surgery. Some studies suggested that obese patients have a lower eradication rate and the Body Mass Index could be independent risk factor for this failure. Objective. To evaluate the H. pylori eradication of a 14 days Quadruple Concomitant therapy in obese patients undergoing bariatric surgery compared against a control group. Material and Methods. Prospective study included 76 patients undergoing bariatric surgery and 75 control patients with a normal BMI and dyspepsia. Results. In the obese group, the eradication rate was 69% whereas in the control group was 89%. p < 0.05, Odds ratio 3.18 (CI 1.35-7.45). The distribution of age, gender, smoking and diabetes did not differ significantly between the two groups. Conclusions. Obese patients showed a significantly lower eradication of H. pylori than controls to a two weeks Quadruple Concomitant therapy.

Objective To describe the frequency of anti-RNA polymerase III antibody in patients with Systemic Sclerosis (SSc) of a group of healthcare centres from Argentina and to explore differences among patients with positive and negative anti-RNA polymerase III antibody. Patients and methods Data from clinical records, anamnesis and physical examination were collected from 135 patients with SSc (ACR/EULAR 2013). A serum sample from each patient was obtained for the detection of anti-RNA polymerase III IgG antibodies by ELISA. Results In all, 97.8% were women and the median age at diagnosis was 53 years (range 12–87), 77.7% had limited cutaneous SSc (lcSSC), 19,3% patients had diffuse cutaneous SSc (dcSSC) and 2.9% had scleroderma sine scleroderma. The 67.5% of the patients were from a Mestizos or Amerindian ethnic group. Anti-RNA polymerase III was positive in 5.9% of the patients. In 36 patients, the anticentromere (ACA) and anti-Scl70 antibodies were negative; anti-RNA polymerase III was positive in 16.7% of these 36 patients. Pitting scars and pulmonary artery hypertension were more frequent in anti-RNA polymerase III positive patients who were also older at diagnosis. No association with gastric antral vascular ectasia was found. The only patient with scleroderma renal crisis was anti-RNA polymerase III positive. Conclusions Anti-RNA polymerase III frequency found in this study was one of the lowest reported, which could be related to the predominance of the Amerindian and Mestizo ethnic group. It is possible that the detection of anti RNA polymerase III allows better classification of SSc patients, to know their prognosis and to improve their follow-up, therefore more studies are needed.

Azathioprine is a thiopurine which has a narrow therapeutic index and marked hematological and hepatic toxicity. Thiopurine s-methyltransferase is an enzyme involved in the metabolism of thiopurines. Mutations in the gene that encodes the enzyme may augment the risk of adverse events. For that reason, pharmacogenetic determinations prior to the initiation of therapy can provide useful information for the future therapeutic strategy. Nevertheless, its utility in the local environment is not completely established. Forty-five subjects (13 men) who had been prescribed azathioprine were included. The presence of *2, *3A, *3B and *3C mutations were determined by PCR-RFLP, and the relationship between genotype and incidence of adverse events related to the drug was analyzed. Nine carried at least one non-functional allele, one of them with *3A/*3A genotype. Among the eighteen patients who initiated treatment with azathioprine, toxicity was detected in 3 cases: 2 mild events were observed in patients with normal genotype, and the only serious event (bone marrow suppression) occurred in the individual with homozygous mutant genotype. The only homozygous mutant patient developed the most severe of the registered events, in spite of being under treatment with low doses of azathioprine. This is the reason why enzymatic determination could be of utility, even though it does not replace clinical and biochemical follow-up in patients under thiopurine treatment.

Obstructive Sleep Apnea Syndrome is a disease with a growing prevalence worldwide that significantly affects quality of life and increases cardiovascular morbidity and mortality.To describe symptoms, comorbidities and anthropometry of patients who were clinically evaluated and underwent sleep studies to identify variables associated with a Respiratory Disturbance Index (RDI) equal or greater than 15.We reviewed data from a self-administered questionary, anthropometry, comorbidities and sleep studies of patients who consulted for the first time at a sleep medicine practice from June 2012 through May 2016.Among 366 patients included we found 47.5% with a RDI30, 21.9% with a RDI 15 – 29.9, 22.1% with a RDI 5 – 14.9 and 8.5% with a RDI5. A multivariate model was built using RDI≥15 as the dependent variable. It showed that snoring more than 3 nights per week (OR 2.89, 95%CI 1.66 – 5.05), BMI ≥ 35 Kg/m2 (OR 2.53, 95%CI 1.35 – 4.72), witnessed apneas almost every night or every night (OR 1.95, 95%CI 1.09 – 3.49), male sex (OR 1.81, 95%CI 1.10 – 2.97) and the presence of high blood pressure (OR 1.67, 95%CI 1.02 – 2.74) were the most significant clinical factors.In our sample, the most significant predictors of a RDI15 were: snoring more than 3 nights per week, BMI ≥ 35 Kg/m2, witnessed apneas almost every night or every night, male sex and the presence of high blood pressure.El sindrome de Apneas Hipopneas Obstructivas del sueño (SAHOS) es una patología con una prevalencia en aumento que produce un impacto significativo en la calidad de vida y en la morbimortalidad, fundamentalmente cardiovascular. Objetivos:Describir síntomas, comorbilidades y medidas antropométricas de pacientes evaluados clínicamente y sometidos a estudios de sueño para identificar variables que se asocian a un Índice de Perturbación Respiratoria (IPR) mayor o igual a 15.Se revisaron cuestionarios autoadministrados, antropometría, comorbilidades y estudios de sueño de los pacientes que consultaron por primera vez en el consultorio de patología respiratoria del sueño entre junio de 2012 y mayo de 2016.Entre los 366 pacientes incluidos se encontró 47.5% con IPR30, 21,9% con IPR 15-29.9, 22,1% con IPR 5-14.9 y 8.5% con IPR5. El modelo multivariado usando el IPR≥15 como variable dependiente demostró que una frecuencia de ronquido mayor a 3 noches por semana (OR 2.89, 95%IC 1.66 - 5.05), el IMC≥35 Kg/m2 (OR 2.53, 95%IC 1.35 - 4.72), apneas presenciadas todas o casi todas las noches (OR 1.95, 95%IC 1.09 - 3.49), el sexo masculino (OR 1.81, 95%IC 1.10 - 2.97) y la presencia de hipertensión arterial (OR 1.67, 95%IC 1.02 - 2.74) fueron los factores clínicos más significativos.En nuestra muestra, los predictores más significativos de la presencia de un IPR≥15 fueron: una frecuencia de ronquido mayor a 3 noches por semana, el IMC≥35 Kg/m2, apneas presenciadas todas o casi todas las noches, el sexo masculino y la presencia de hipertensión.

Forced vital capacity (FVC) is commonly used to evaluate severity, progression, prognosis and therapeutics in IPF. However, FVC has shown significant variability in IPF evaluation leading to differences in the assessment of disease severity and evolution. Slow expiratory vital capacity (SVC) has not been systematically explored in IPF. The aim of the study was to compare baseline FVC and SVC in a group of patients with diagnosis of IPF. Methods: A retrospective study was carried out. Spirometry and plethysmographic lung volumes were obtained according to ATS-ERS Statement. Diagnosis of IPF was based on ATS/ERS/JRS/ALAT 2018 guidelines. Combined IPF-emphysema (CPFE) was excluded. Sign rank Wilcoxon test was used. Results: Fifty four (78% males) patients, age 64 (59-72) years, 40 (74%) ex-smokers with IPF were studied. Table shows PFTs of the studied population. Forty two (78%) patients showed higher SVC than FVC at baseline. SVC was significantly higher than FVC: 110 (20-170) mL (p FVC and the group SVC≤FVC. Conclusions: Spirometric baseline condition of IPF seems to be more accurately assessed by SVC than FVC. The uneven impact of heterogeneous IPF lesions on lung volumes and flows could account for the higher SVC that we found in almost 80% of patients. Prospective studies are needed to determine the utility of SVC for IPF evaluation.

To describe the visual prognosis and remission rate of chronic anterior uveitis in pediatric patients.A retrospective case series of children with chronic anterior uveitis treated in the University of Buenos Aires. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Uveitis remission was defined according to SUN criteria.There were 35 pediatric patients (61 eyes), mean age of uveitis onset was 7.69 ± 3 years, 60% were females and 74% had bilateral disease, median follow-up was 60 months (range: 12-192 months). JIA was more frequent in females (80.95 vs 21.43; p0.0001) and oligoarthritis was the most common form. Remission rate was higher in males (HR = 4.99; 95% CI = 1.16-21.51; p = 0.031). More than 40 eyes remained with the same BCVA at 1 year of follow-up.Although remission was not common and only occurred after long-term follow-up, visual prognosis was good Received 30 August 2015; revised 6 March 2016; accepted 14 March 2016; published online 18 May 2016.

Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE). A retrospective analysis was carried out on a group of 24 patients with SLE to evaluate whether the presence of anti-C1q antibodies (anti-C1q) is related to renal involvement and to explore the behaviour of anti-C1q with respect to LN during a four-year follow-up period. A first serum sample stored at the serum bank, taken not more than three years after SLE diagnosis and one serum sample per year for the subsequent four years were used to detect anti-C1q. Lupus clinical manifestations and serological markers of activity corresponding to the date of each serum sample selected were collected from medical records. In the first serum sample, anti-C1q were found in 8 active SLE. LN was confirmed by histology in 5/8 patients who were positive for anti-C1q and in 1/16 patients who were negative for these autoantibodies (p = 0.0069). Three patients (3/8) had anti-C1q without renal involvement but with lupus skin manifestation. Anti-C1q levels decreased in 3/5 patients with LN who responded to treatment and remained higher in 2/5 patients who needed a new renal biopsy which showed severe renal disease. The 15 patients without severe kidney disease and anti-C1q negative at diagnosis did not develop LN and anti-C1q remained negative in the 4 years of follow up. Anti-C1q were found in SLE patients with active renal involvement or with lupus skin disease. The absence of anti-C1q seemed to be linked to low probabilities of renal involvement.

Background: Low total T is associated with an increased risk of atherosclerotic complications. However, the magnitude of this association in middle-aged patients with type 2 diabetes (T2D) has not been determined. Materials and Methods: This cross-sectional study evaluated atherosclerotic disease markers in T2D patients with normal and low plasma total T. A total of 115 male patients, aged younger than 70 years, without a history of cardiovascular events, and with normal [≥3.5 ng/mL (≥12.1 nmol/L), n = 79] or low [< 3.5 ng/mL (≤12.1 nmol/L), n = 36] total T underwent the measurement of highly sensitive C-reactive protein, carotid artery carotid intima-media thickness (IMT), and atherosclerotic plaque by high-resolution B-mode ultrasound and to asses endothelial function by brachial artery flow-mediated dilation. Results: Carotid IMT was negatively correlated with total T concentration (r = −0.39, P < .0001). Compared with subjects with normal T, a higher proportion of patients with low total T had carotid IMT of 0.1 cm or greater [80% vs 39%, odds ratio (OR) 6.41; 95% CI 2.5–16.4, P < .0001], atherosclerotic plaques (68.5% vs 44.8%, OR 2.60, 95% CI 1.12–6.03, P < .0001); endothelial dysfunction (80.5% vs 42.3%, OR 5.77, 95% CI 2.77–14.77, P < .003), and higher highly sensitive C-reactive protein levels (2.74 ± 5.82 vs 0.89 ± 0.88 mg/L, P < .0001). Similar results were found when free T was considered. Multiple logistic regression analyses adjusted for age, diabetes mellitus duration, hemoglobin A1c, lipids, treatment effect, and body mass index reported that a low total T level was independently associated with greater IMT [OR 8.43 (95% CI 2.5–25.8)] and endothelial dysfunction [OR 5.21 (95% CI 1.73–15.66)] but not with the presence of atherosclerotic plaques (OR 1.77, 95% CI 0.66–4.74). Conclusions: Low T is associated with more advanced atherosclerotic disease markers in middle-aged patients with T2D.

Radical nephrectomy is associated with a progressive decline in renal function. Clinical parameters in post-nephrectomy insufficiency were described but the impact of histopathologic vascular findings in the non-neoplastic kidney of nephrectomy specimen, has been poorly studied. Our aim was to evaluate whether the severity of atherosclerosis in non-neoplastic renal tissue predicts the evolution of glomerular filtration rate in patients undergoing total nephrectomy. Thirty-one non-donor patients with unilateral radical nephrectomy were included. Average age was 68.5 ± 11.8 years, 80% had a history of hypertension, 64% overweight and 51% were smokers. The glomerular filtration rate was estimated preoperatively, postoperatively and at 6, 12 and 24 months after surgery. Arteriolosclerosis was scored based on degree of narrowing of the vascular lumen (stage 0: no vascular narrowing; stage 1: less than 25%; stage 2: 25-50%; stage 3: more than 50%). Ten patients in stage 0 had higher basal glomerular filtration rate (75 ± 13 ml/min/1.73 m2) than eight patients in stage 2 or 3 (55 ± 22 ml/min/1.73 m2) (p 0.0886). At the last postoperative evaluation, the glomerular filtration rate was 60 ± 13 ml/min/1.73 m2 (stage 0) and 39 ± 11 ml/min/1.73 m2 (stage 2 or 3) (p = 0.05). The decrease in glomerular filtration rate was higher in patients with more severe degrees of atherosclerosis but the difference was not statistically significant. The histological evaluation of the severity of arteriosclerosis in the whole kidney allows the identification of patients with a greater risk of decreased glomerular filtration rate after a post radical nephrectomy.

Purpose: To evaluate the clinical outcome and safety of adalimumab in patients with Vogt–Koyanagi–Harada (VKH) disease.Methods: VKH patients treated with adalimumab seen at the University of Buenos Aires were reviewed. Main outcome measures were visual acuity, anterior segment inflammation, optic nerve inflammation (ONI), steroid sparing effect, number of immunosuppressives, and relapses.Results: In total, 14 VKH patients, mean age 23.07 ± 8 years; median of adalimumab treatment 10 months, were analyzed. At start of adalimumab treatment (baseline), median of corticosteroid dose was 20 mg and at 6 months, 4 mg. At baseline, 11 patients were on immunosuppressive treatment and at 6 months only four continued with immunosuppressive therapy. In the 28 eyes, the median of active inflammation was 2 at baseline and 0 after 6 months on adalimumab.Conclusions: Treatment with adalimumab is an effective and safe option, reducing the need for oral corticosteroid and conventional immunosuppressive therapy.

The idiopathic inflammatory myopathies(IIM) are a heterogeneous group of diseases of the skeletal muscle. On the basis of clinical, serologic and histological differences, they are classified in dermatomyositis (DM), polymyositis (PM), inclusion body myositis and immunomediated necrotizing myopathy. Autoantibodies directed against nuclear and cytoplasmic antigens are present with variable frequencies among studies. Myositis-specific antibodies (MSAs) are useful in IIM because they contribute to the diagnosis, help to identify different clinical subsets, and have prognostic value. This study aimed to explore the frequency of autoantibodies, especially MSAs, and their relationship with clinical features in adult patients with DM, PM and overlap syndrome. Medical records were reviewed. Myositis-associated antibodies (non-specific) and MSAs (anti Jo-1, PL-7, PL-12, Mi-2 and SRP) were measured using commercial kits. Twelve patients had MSAs, an overall frequency similar to those of international series, but PL-12 and Mi-2 were more frequent than Jo-1, which is the most frequently observed elsewhere. All five patients with Mi-2 had classical DM with a favorable response to treatment. Interstitial pneumonia (n: 4) and/or treatment-refractory disease (n: 3) were found in the presence of anti-PL-12, alone or associated with anti-SRP and/or Jo-1. In conclusion, the coexistence of AEM, a rare finding, was found in three patients. The presence of MSAs aided to the diagnosis of IIM, in particular in those patients without available or conclusive biopsy results.

Background There is controversy in medical literature over the outcome of patients with lupus nephritis (LN) class II. The aim of this study was to explore the risk of histological transformation (HT) and possible factors related to negative response to treatment in patients with mesangial LN class II. Methods A retrospective and multicenter study was carried out that includes patients who had received a diagnosis of LN class II on their first renal biopsy. Creatinine, urine sediment, and proteinuria were recorded at the time of the first biopsy, 6 months, and 1, 2, and 5 years after the first biopsy. Response to treatment, HT, and long-term outcome were evaluated. Results Forty-one patients were included. The manifestation at first biopsy was proteinuria greater than 0.5 g/d in 28 patients (68.29%; 8 [28.57%] of 28 patients had nephrotic syndrome), hematuria in 18 patients (43.90%), and deterioration of renal function in 3 patients (7.31%). During the follow-up (median, 8 years; range, 1–35 years), a new biopsy was performed in 18 patients (43.90%), and in 17 patients (17/18 [94.44%]), there was HT. Median time at rebiopsy was 32 months (range, 11–305 months). Of the 18 patients who had a second biopsy, 10 (55.55%) were on hydroxychloroquine versus 100% (19/19) of patients who did not undergo the procedure (P = 0.001). A year after the first renal biopsy, there are data available from 34 patients; of them, 24 patients (70.58%) had achieved response, and 10 patients (29.41%) had no response (NR) (missing data in 7). A higher 24-hour urinary protein at 6 months was predictor of worse outcome at 1 year, with statistical significance difference for the nonresponder group (median proteinuria, 2.3 g/d [range, 0–4.7 g/d]) compared with responders (median proteinuria, 0.28 g/d [range, 0–1.7 g/d]) (P = 0.0133). In the long-term follow-up (5 years), HT was the main cause of unfavorable outcome and was measured in 78.57% of patients (11/14 patients). Conclusions This series shows a high rate of HT in long-term follow-up. Proteinuria at 6 months made it possible to set aside patients who will have an unfavorable outcome in the long term and who will thus benefit from a more aggressive treatment. The results suggest that hydroxychloroquine had a nephroprotective effect.

The higher incidence of breast cancer, the improvements in diagnosis and treatment, together with the growing life expectancy have brought about an increase in the number of patients at risk for bilateral breast carcinoma. The aim of this study is to describe the characteristics of patients suffering from bilateral breast carcinoma who underwent surgery at the Breast Pathology Service of the Buenos Aires British Hospital and to analyze impact on survival. Between January 1970 and May 2007, 4,085 cases of breast carcinoma in 3,864 patients were treated at the Breast Diseases Division of the Buenos Aires British Hospital. A retrospective study of 194 patients with bilateral breast carcinoma was carried out: 80 synchronous and 114 metachronous. In order to compare survival, a group of 2,237 patients with unilateral breast carcinoma who had undergone surgery was analyzed. The risk of developing a contralateral breast carcinoma was 0.9% per year, with an accumulated risk at 15 years of 12.75%. The 5-year survival was 85.9% for unilateral carcinomas, 94.6% for metachronous carcinoma, and 63.3% for synchronous carcinoma. The 15-year survival was 65.5% for unilateral carcinomas, 52.3% for metachronous, and 37.2% for synchronous. The incidence of bilateral carcinomas is low. Survival was worse in patients with metachronous carcinoma diagnosed within 5 years of the first malignancy. Survival in patients with metachronous carcinoma diagnosed after 5 years is similar to those with unilateral carcinoma. Synchronous carcinoma was associated to worse survival, being an independent risk factor for mortality.

Introduction: Immune humoral neutropenia (Np) could be the consequence of anti-polymorphonuclear neutrophil (PMN) antibodies, circulating immune complexes (CIC) and/or antibodies against myeloid precursors. Granulocyte immunofluorescence test (GIFT) and a leukoagglutination technique (LAGT) assays are recommended for its diagnosis. Methods: Fifty adult patients with secondary Np were screened for anti-PMN. GIFT by flow cytometry from viable PMN and LAGT were employed. In addition, CIC levels, low expression of CD16b (CD16 blow), PMN phenotype and sera tumor necrosis factor- alpha (TNF-α) were also evaluated. Results: Direct IgG-PMN binding (dir-GIFT) was positive in 16% of the patients. Antibodies against autologous PMN were detected in 32% of the samples by indirect (ind)-GIFT and demonstrated in 70% of the sera by both ind-GIFT and/ or LAGT. Predominance of human neutrophil alloantigen (HNA)-1b and HNA-2 expression was confirmed. CD16b low was detected in 16% of the patient's PMN and TNF-α in 68% of sera patients. Conclusion:Our results suggest that diagnosis of immune Np in the laboratory may be improved by focusing on patient's PMN together with the assessment of cellular markers. © 2009 Blackwell Publishing Ltd. Fil: Riera Cervantes, Norma Edith. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Rosso Saltó, M.. Asociación Española Primera de Socorros Mutuos Montevideo; Uruguay Fil: Galán, V.. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Canalejo, K.. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Khoury, M.. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Aixalá, M.. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Kantor, G. L.. Hospital Durand; Argentina Fil: Vermeulen, Elba Monica. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: Bengló, R.. Academia Nacional de Medicina de Buenos Aires; Argentina Fil: de Elizalde, Maria Marta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Academia Nacional de Medicina de Buenos Aires; Argentina

La neutropenia inmune se diagnostica por la presencia de auto o aloanticuerpos reactivos con los neutrófilos. La neutropenia aloinmune neonatal es consecuencia de la sensibilización materna a los antígenos específicos de los neutrófilos paternos que afectan al neonato al atravesar la barrera placentaria. Se presentan 4 casos de niños, 2 de ellos hermanos consanguíneos con doble vínculo. Se estudiaron los sueros de los pacientes y sus padres. Por citometría de flujo se establecen los valores de referencia de la IgG sérica reactiva con los neutrófilos en voluntarios sanos, para 3 diluciones (1/2, 1/5 y 1/20) en reacción autóloga (suero y células de un mismo individuo) y heteróloga (suero y células de diferentes individuos). Los resultados se expresan por un índice definido como el cociente entre la mediana de la intensidad de fluorescencia media del suero incógnita y la de un suero utilizado como referencia. Por leucoaglutinación se evaluó la dilución del suero 1/20. Se determinó el nivel de complejos inmunes circulantes. Se determinó el fenotipo, para los epitopes HNA-1a, HNA-1b y HNA-2a. En los 4 niños se encontró IgG reactiva y/o factores aglutinantes; 2/3 sueros maternos fueron reactivos con los neutrófilos del cónyuge y de los hijos. Los complejos inmunes circulantes fueron positivos en 2/4 sueros negativos en 3/3 sueros maternos. Se encontró incompatibilidad materno-infantil en los 4 casos. Las 3 madres tenían igual fenotipo: homocigotos NA1/NA1, NB1+. En síntesis, se presenta el hallazgo de 4 casos con neutropenia inmune: 3/4 auto-inmune, 1/3 se asocia a complejos inmunes circulantes y 1/4 con neutropenia neonatal aloinmune.Auto or alloantibodies reactive with neutrophils define immune neutropenia. Alloimmune neonatal neutropenia is caused by maternal sensitization to paternal neutrophil antigens, resulting in IgG antibodies that are transferred to the fetus through the placenta. We present the studies in 4 children from 3 families with neutropenia of unknown origin (two of them were brothers). They were evaluated by flow cytometry in parallel with leukoagglutination. Reference values were established for serum reactive IgG in healthy volunteers for three dilutions (1/2, 1/5 and 1/20), both for the autologous reaction (serum and cells of the same individual) and for the heterologous reaction (serum and cells of different individuals). Results were expressed by an index defined by the quotient of the mean fluorescence intensity of the patient's serum divided by that of the reference serum. Serum reactive/agglutinant factors and circulating immune complexes were evaluated in patients and parents serum. Neutrophil specific phenotypes were determined for HNA-1a, HNA-1b and HNA-2a. Reactive IgG/agglutinant factors were found in 4 children. Two maternal sera were reactive against paternal and/or children neutrophils. Circulating immune complexes were detected in 2/4 children sera and were negative in 3/3 maternal sera. Maternal/children incompatibility was detected in the four cases. The three mothers had the same phenotype: homozygous NA1/NA1, NB1+.

To the Editor: Ocular toxoplasmosis (OT), caused by the parasite Toxoplasma gondii, is known to be a major health problem in South America, especially in Colombia and Brazil (1–3). The highest prevalence of OT has been reported in Erechim, Rio Grande do Sul, Brazil, a state that borders Uruguay and Argentina, where a representative population-based household survey showed that 17.7% of 1,042 adults examined had OT (1). For comparison, it is estimated that ≈2% of T. gondii–infected persons in the United States manifest OT (4). It is still unclear whether the high rate of OT in South America is attributable to host or parasite genetic factors or differences in exposure rate (5,6). In the province of Misiones in Argentina, the prevalence of OT in patients seeking care in an ophthalmic office is also high and has been documented as high as 20% (7). The area was mostly settled in the early 20th century by non-Hispanic European immigrants from Germany and Slavic countries who arrived through Southern Brazil. We explored the relationship between ethnic origin and frequency of reactivation toxoplasmic retinochoroiditis (RTR) in patients who sought care in a private secondary care eye clinic in Obera, Misiones, Argentina, during February 2004–May 2014. All patients with uveitis were examined by a single uveitis specialist (M.R.), who performed complete ophthalmological examinations, including visual acuity, anterior biomicroscopy, tonometry, and indirect ophthalmoscopy. Study inclusion criteria were presence of RTR in 1 or both eyes and specific T. gondii IgG in blood serum samples. A minimum of 3 months with no signs of intraocular inflammation was required to differentiate chronic active retinochoroiditis from 2 consecutive episodes of RTR. The study included 112 nonimmunosuppressed patients with RTR. The patients completed a questionnaire including demographic data for the patient, as well as the first and last names and countries of origin of parents, grandparents, and great-grandparents. Informed consent was obtained from all participants and the study was approved by the human subjects review committee of Misiones Province. The patients were divided into 4 groups (Table): 1) patients reporting >1 ancestor born in Spain were considered Hispanic (n = 29); 2) patients without Hispanic ancestry who had >1 ancestor born in Poland, Ukraine, Russia, or Belarus, and who spoke Polish, Ukrainian, or Russian were considered Slavic (n = 28); 3) patients without Hispanic or Slavic ancestry who had >1 ancestor born in Germany or the Austro-Hungarian Empire and who spoke German were considered Germanic (n = 46); and 4) patients who did not fulfill the criteria of any of the above-mentioned groups were designated as others (n = 9). All patients had RTR at baseline; 28 had >1 more RTR episode during the follow-up period (Table). Multiple logistic regression analysis, in which Hispanic patients were used as a reference group, showed that Germanic and Slavic patients had a higher risk for reactivation during the follow-up period, but the odds ratio was significant only for Slavic patients after adjustment for rural dwelling. Table Demographic baseline characteristics of patients with reactivation of OT and multiple logistic regression analysis of the association between ethnic origin and risk for RTR during follow-up, Misiones province, Argentina, 2004–2014* More than 95% of Toxoplasma gondii strains in Europe belong to the clonal type II lineage, whereas strains from South America are genetically divergent and diverse (6,8). We hypothesize that the European population is poorly adapted to South American strains and therefore more susceptible to OT. If this hypothesis is true, Native Americans who had a long history of exposure to atypical strains from South America should be more resistant to OT. This hypothesis is reinforced by a recent survey conducted among Mbya-Guarani Indians, who had a serologic prevalence of toxoplasmosis 70%, but only 3.5% of them had toxoplasmic retinochoroidal lesions (M. Rudzinski, unpub. data). Argentineans have a large incidence of European genetic heritage in their Y-chromosomal and autosomal DNA, but ≈50% of their mitochondrial gene pool is of Native American ancestry (9). The amount of admixture between Europeans and Native Americans with inheritance of resistance genes to OT from Native Americans may explain the difference of susceptibility to RTR between Hispanic and non-Hispanic Europeans. Admixture events between Europeans and Native Americans mainly involved Hispanics whose migration to Argentina started in the 16th century and continued until the mid-20th century. Persons in Argentina who have Spanish surnames can carry as much as 80% Native American genetic ancestry (9,10). In contrast, the Slavic and German Europeans migrated to Misiones only during a large surge of European immigration between 1890 and 1950, and did not have substantial admixture with Native Americans. Despite the fact that this study was not a random or representative sample of all ethnic groups in Argentina and the Native American mixture of the patients was not known, and environmental and dietary influences were not examined, our results suggest host genetic factors as determinants of disease severity in OT.

Objective. To determine outcome and natural course of systemic inflammatory response syndrome (SIRS) stages in adult febrile neutropenic patients. Design and setting. Retrospective cohort study in the medicine department and intensive care unit of a university hospital. Patients. Adults with cancer-related neutropenia and community-acquired fever. Measurements and results. Patients were classified on admission according to SIRS parameters, tumor type, and degree of neutropenia. Records of clinical and laboratory data during hospitalization were reviewed. Univariate and logistic regression analyses were performed. Seventy-nine events in 62 patients were analyzed. Overall mortality rate was 20.2% (16/79). Mortality increased as SIRS stage worsened on admission. No patients with stage 2 SIRS died (neutropenia and fever alone) but 11.1% of patients with SIRS 3, 43.4% with SIRS 4, 66.6% with sepsis induced hypotension, and 90% with septic shock. SIRS stage on admission was an independent predictor of death and was related directly to rate of progression to shock, i.e., none of the patients with SIRS 2, 2.7%(1/36) of those with SIRS 3, and 30.4% (7/23) of those admitted with SIRS 4. Conclusions. Mortality and progression to septic shock increased as more SIRS criteria were met on admission. SIRS stages could serve as a risk-assessing model in febrile neutropenic patients.

Participation in a Pulmonary Rehabilitation Program (PRP) improves dyspnea, functional capacity and quality of life in patients with chronic respiratory disease. A retrospective study was carried out to identify variables related to compliance in an out patient PRP at an Argentine center and to evaluate the results in compliant patients. The PRP included an "acquisition" stage consisting of 16 weeks of supervised training twice weekly and lectures on treatment benefits, inhalation devices used, smoking cessation, symptoms recognition and flair up management, among others. Patients were reassessed after this stage. Patients completing the acquisition stage were considered PRP compliant. Of 388 patients evaluated for admission 102 (26.3%) complied with PRP. Multiple logistic regression analysis (Forward Stepwise; p0.10 to be eligible for entry into the model) was used to identify factors related to "program compliance". The final model was as follows: having health insurance coverage (OR = 3.99; CI90% = 2.24-7.12), commute time under 60 minutes (OR = 2.07; CI90% = 1.37-3.11) and financial capacity (OR = 2.11; CI90% = 1.03-4.31). All patients complied with the PRP showed significant improvement in the six-minute walking test and quality of life. The results warn about low compliance and their relationship with socioeconomic variables.

Background: Reactivation of toxoplasmic retinochoroiditis is the most frequent form of uveitis in Misiones, Argentina. Fluctuations in the number of patients consulting with this type of uveitis were detected during the last decade. Since the province was consecutively exposed to rainy and dry periods over the last years, we decided to explore whether a relationship between reactivation of toxoplasmic retinochoroiditis and rain might be established according to the data registered during the 2004–2010 period. Results: The frequency of toxoplasmic reactivation episodes increases when precipitation increases (mostly in second and fourth trimesters of each year). Analysis of the independent variables demonstrates that precipitation is a significant predictor of the frequency of reactivation episodes. Although registered toxoplasmic reactivations were more frequent during the third trimester of the year, the association between the third trimester and the reactivation episodes did not reach statistical significance. Conclusion: Prolonged and intense rainfall periods were significantly associated with the reactivation of toxoplasmic retinochoroiditis. Changes promoted by this climatic condition on both the parasite survival in the soil as well as a putative effect on the host immune response due to other comorbidities are discussed.

The higher incidence of breast cancer, the improvements in diagnosis and treatment, together with the growing life expectancy have brought about an increase in the number of patients at risk for bilateral breast carcinoma. The aim of this study is to describe the characteristics of patients suffering from bilateral breast carcinoma who underwent surgery at the Breast Pathology Service of the Buenos Aires British Hospital and to analyze impact on survival. Between January 1970 and May 2007, 4,085 cases of breast carcinoma in 3,864 patients were treated at the Breast Diseases Division of the Buenos Aires British Hospital. A retrospective study of 194 patients with bilateral breast carcinoma was carried out: 80 synchronous and 114 metachronous. In order to compare survival, a group of 2,237 patients with unilateral breast carcinoma who had undergone surgery was analyzed. The risk of developing a contralateral breast carcinoma was 0.9% per year, with an accumulated risk at 15 years of 12.75%. The 5-year survival was 85.9% for unilateral carcinomas, 94.6% for metachronous carcinoma, and 63.3% for synchronous carcinoma. The 15-year survival was 65.5% for unilateral carcinomas, 52.3% for metachronous, and 37.2% for synchronous. The incidence of bilateral carcinomas is low. Survival was worse in patients with metachronous carcinoma diagnosed within 5 years of the first malignancy. Survival in patients with metachronous carcinoma diagnosed after 5 years is similar to those with unilateral carcinoma. Synchronous carcinoma was associated to worse survival, being an independent risk factor for mortality.

Auto or alloantibodies reactive with neutrophils define immune neutropenia. Alloimmune neonatal neutropenia is caused by maternal sensitization to paternal neutrophil antigens, resulting in IgG antibodies that are transferred to the fetus through the placenta. We present the studies in 4 children from 3 families with neutropenia of unknown origin (two of them were brothers). They were evaluated by flow cytometry in parallel with leukoagglutination. Reference values were established for serum reactive IgG in healthy volunteers for three dilutions (1/2, 1/5 and 1/20), both for the autologous reaction (serum and cells of the same individual) and for the heterologous reaction (serum and cells of different individuals). Results were expressed by an index defined by the quotient of the mean fluorescence intensity of the patient's serum divided by that of the reference serum. Serum reactive/agglutinant factors and circulating immune complexes were evaluated in patients and parents serum. Neutrophil specific phenotypes were determined for HNA-1a, HNA-1b and HNA-2a. Reactive IgG/agglutinant factors were found in 4 children. Two maternal sera were reactive against paternal and/or children neutrophils. Circulating immune complexes were detected in 2/4 children sera and were negative in 3/3 maternal sera. Maternal/children incompatibility was detected in the four cases. The three mothers had the same phenotype: homozygous NA1/NA1, NB1+.

Road accidents are a major cause of death, and sleep deprivation affects driving skills. We conducted a cross-sectional study to evaluate sleep habits and accident risk in long-haul truck drivers in Buenos Aires, Argentina. Questionnaires regarding sleep habits, snoring, and daytime sleepiness were administered, and a limited physical examination was performed. We obtained 738 complete answers (response rate 85%). Mean sleep hours during working days was 3.76 (SD 2.40). Mean driving hours was 15.9 (SD 5.60) per day. Frequent sleepiness while driving was reported by 43.7% of responders. Sleepiness while driving was associated with Epworth Sleepiness Scale values >10 (odds ratio 1.85, 95% confidence interval = 1.20-2.85). Snoring was reportea by 71% of drivers and was frequent in 43.8%. Snoring more than 3 times a week (odds ratio 1.73, 95% confidence interval = 1.23-2.44), sleepiness while driving (OR 1.92, 95% confidence interval = 1.08-1.96), and Epworth Sleepiness Scale score > 10 (odds ratio 2.53, 95% confidence interval = 1.61-3.97) were independently associated with reporting of accidents or near accidents. Sleep deprivation and long driving shifts were prevalent in our study. Accident risk was associated with frequent snoring, daytime sleepiness, and reporting of sleepiness at the wheel. This study highlights the need of improving working conditions in this highly exposed population.