[Hydatidosis: Ultrasonographyc screening in the Río Negro Province 25 years after the first screening]. / Hidatidosis: Catastro ecográfico en la Provincia de Río Negro 25 anos después del primer catastro.

INTRODUCTION: Hydatidosis (cystic echinococcosis) is endemic in Rio Negro Province, Argentina. In 1980 started a control program against the disease. In 1984 Frider et al performed the first ultrasound screening in the world at Pilcaniyeu city, later extended to other localities of Rio Negro province. The initial prevalence in asymptomatic people was 7.1% in Pilcaniyeu and 10.1% in Comallo, being all new cases and with surgical indication. OBJECTIVE: The aim of this investigation was to determine the current prevalence and analyze the evolution of the disease across 25 years of the control program. MATERIALS AND METHODS: In 2009 and 2010 ultrasound screening studies were conducted in both locations in all age groups. RESULTS: In 512 ultrasound studies at Pilcaniyeu, the prevalence was 1.5% in children (6 to 14years old) and 4.2% in adults (total 2.5%). In 770 ultrasound studies at Comallo, the prevalence was 1.1 %in children and 6.6% in adults (total 3.0%). The overall reduction in the prevalence reached 67.2%. Regarding the age distribution, rates of 1.6%-1.9% were observed in Pilcaniyeu and of 1.0-1.9% in Comallo between 0 and 30 years old, increasing significantly above 10% after 60 years old in Pilcaniyeu and after 40 years old in Comallo. CONCLUSIONS: The implementation of the program actions reduced the prevalence of the disease but there are still new cases, and that indicates that some bias persists in the control of the epidemiology of the disease and levels of transmission to humans as a consequence of this failures. So the search of asymptomatic cases is still important and also their management based on the follow-up by ultrasound (watch and wait) or in the treatment with albendazol.

[Hydatidosis: Ultrasonographyc screening in the Rio Negro Province 25 years after the first screening]. / Hidatidosis: Catastro ecográfico en la Provincia de Río Negro 25 años después del primer catastro.

INTRODUCTION: Hydatidosis (cystic echinococcosis) is endemic in Río Negro Province, Argentina. In 1980 started a control program against the disease. In 1984 Frider et al performed the first ultrasound screening in the world at Pilcaniyeu city, later extended to other localities of Rio Negro province. The initial prevalence in asymptomatic people was 7.1% in Pilcaniyeu and 10.1% in Comallo, being all new cases and with surgical indication. OBJECTIVE: The aim of this investigation was to determine the current prevalence and analyze the evolution of the disease across 25 years of the control program. MATERIALS AND METHODS: In 2009 and 2010 ultrasound screening studies were conducted in both locations in all age groups. RESULTS: In 512 ultrasound studies at Pilcaniyeu, the prevalence was 1.5% in children (6to 14years old) and 4.2% in adults (total 2.5%). In 770 ultrasound studies at Comallo, the prevalence was 1.1% in children and 66% in adults (total 3.0%). The overall reduction in the prevalence reached 67.2%. Regarding the age distribution, rates of 1.6%-1.9% were observed in Pilcaniyeu and of 1.0-1.9% in Comallo between 0 and 30 years old, increasing significantly above 10% after 60 years old in Pilcaniyeu and after 40years old in Comallo. CONCLUSIONS: The implementation of the program actions reduced the prevalence of the disease but there are still new cases, and that indicates that some bias persists in the control of the epidemiology of the disease and levels of transmission to humans as a consequence of this failures. So the search of asymptomatic cases is still important and also their management based on the follow-up by ultrasound (watch and wait) or in the treatment with albendazol.

Prevalence of human cystic echinococcosis in the towns of Ñorquinco and Ramos Mexia in Rio Negro Province, Argentina, and direct risk factors for infection.

BACKGROUND: Cystic echinococcosis (CE) is a parasitic zoonosis caused by infection with the larval stage of Echinococcus granulosus (s.l.). This study investigated the prevalence and potential risk factors associated with human CE in the towns and rural areas of Ñorquinco and Ramos Mexia, Rio Negro province, Argentina. METHODS: To detect abdominal CE cysts, we screened 892 volunteers by ultrasound and investigated potential risk factors for CE using a standardized questionnaire. Prevalence ratio (PR) with 95% confidence intervals (CI) was used to measure the association between CE and the factors investigated, applying bivariate and multivariate analyses. RESULTS: Abdominal CE was detected in 42/892 screened volunteers (4.7%, 95% CI 3.2-6.1), only two of whom were under 15 years of age. Thirteen (30.9%) CE cases had 25 cysts in active stages (CE1, CE2, CE3a, according to the WHO Informal Working Group on Echinococcosis [WHO-IWGE] classification). The most relevant risk factors identified in the bivariate analysis included: living in rural areas (P = 0.003), age > 40 years (P = 0.000), always drinking water from natural sources (P = 0.007), residing in rural areas during the first 5 years of life (P = 0.000) and having lived more than 20 years at the current address (P = 0.013). In the multivariate final model, the statistically significant risk factors were: frequently touching dogs (P = 0.012), residing in rural areas during the first 5 years of life (P = 0.004), smoking (P = 0.000), age > 60 years (P = 0.002) and living in rural areas (P = 0.017). CONCLUSIONS: Our results point toward infection with CE being acquired since childhood and with constant exposure throughout life, especially in rural areas with a general environmental contamination.

Identification of potential 'hot spots' of cystic echinococcosis transmission in the province of Río Negro, Argentina.

Cystic echinococcosis (CE) is a parasitic zoonosis caused by Echinococcus granulosus. The control program of CE of Rio Negro province, Argentina, involves annual surveillance using ultrasound (US) screening in school children, and five-year cross-sectional surveys to detect livestock farms with parasitized dogs by coproELISA with confirmation tests (Western Blot or PCR). Control program is based on deworming of dogs with praziquantel and the aim is to identify areas at risk of Cystic echinococcosis transmission to humans, using all available data sources. The information was spatially distributed in 13 program areas and, at a smaller geographical scale, in 80 Primary Health Care Centers. CoproELISA surveys involved three randomized sampling periods (2003-05, 2009-10, 2017-18), with 1790 canine fecal samples. The US surveys were conducted in 2003-08, 2009-16 and 2017-18 in 34,515 children. Heat maps were created at the smallest geographic scale with QGIS 3.4.6. For the consecutive sampling periods, prevalence of positive canine fecal samples from livestock farms were 14.7, 12.1 and 7.8%, respectively, and children prevalence was 0.4, 0.2 and 0.1%, respectively. The study has been developed on a scale according to which the temporal-spatial distribution of CE allows to adjust control strategies in those areas of potential transmission of the zoonosis to humans.

Epidemiology, diagnosis, treatment and follow-up of cystic echinococcosis in asymptomatic carriers.

Background: Río Negro Province is endemic for cystic echinococcosis (CE). A CE control program includes early diagnosis in humans. During 1980-1996, screening was done with serology and surgery was the unique choice of treatment. Since 1997, ultrasound (US) has been the method of choice for screening, and new choices of treatment for asymptomatic carriers are discussed in the CE guidelines. Methods: Between 1997 and 2016, 42 734 abdominal USs were performed, 192 new asymptomatic cases were diagnosed and underwent a protocol according to the size, location and type of cyst. Treatment options included active surveillance (US monitoring, 83 [43.3%]), antiparasitic (albendazole, 92 [47.9%]) and surgery (17 [8.8%], including percutaneous treatment). Results: After 7.7 y of follow-up, of the cases under active surveillance, 28 (33.7%) had to change treatment: 5 (6%) to surgery and 22 (26.5%) to albendazole. Of the patients treated with albendazole, 3 (3.2%) were operated on and 13 (14%) were treated with a second cycle of albendazole. Conclusion: As a result of the present study, resolution of CE in a non-surgical way with albendazole is confirmed to be effective in asymptomatic carriers with CE1 or CE3a cysts. An update eliminates the strategy of active surveillance in type CE1 cysts <3 cm and is replaced by treatment with antiparasitic in all asymptomatic cases with CE1 or CE3a cysts <10 cm. The update also limits follow-up to 12-18 months to evaluate those cases with non-response to antiparasitic and switch to a surgical option.

Anastomosis pancreático yeyunal ducto-mucosa: resultados inmediatos / Duct-to-mucosa pancreaticojejunal anastomosis

Antecedentes: Los dos objetivos más importantes de la anastomosis pancreaticointestinal luego de la resección de la cabeza de páncreas son evitar la fístula pancreática y preservar la suficiencia exocrina del páncreas. Estudios experimentales indican que la anastomosis que mejor preserva la suficiencia exocrina del páncreas es la pancreaticoyeyunoanastomosis ducto-mucosa. Sin embargo, es considerada una anastomosis difícil o contraindicada en conductos de Wirsung no dilatados. Objetivo: Investigar la factibilidad de la anastomosis pancreaticoyeyunal-ducto-mucosa en una serie consecutiva de pacientes. Lugar de aplicación: Centro terciario de referencia. Diseño: Estudio clínico longitudinal prospectivo. Población: Consecutiva de 20 pacientes en quienes se extirpó la cabeza de páncreas. Métodos: Se determinó la textura del páncreas y diámetro del conducto de Wirsung, previamente a la anastomosis pancreaticoyeyunal ducto-mucosa terminolateral en dos planos. Se evaluó la morbimortalidad postoperatoria. Resultados: La incidencia de fístula fue de 15 por ciento. En muñón pancreático blando y Wirsung no dilatados la incidencia de fístula pancreática fue mayor (20 por ciento) que en los páncreas duros con Wirsung dilatados (10 por ciento), aunque no significativa (p = 1). La morbilidad fue de 30 por ciento, ningún paciente requirió reoperación y no se registró mortalidad en la serie. Conclusiones: Es factible realizar la anastomosis pancreaticoyeyunal en forma segura en cualquier paciente, independientemente de la textura del muñón pancreático y el tamaño del Wirsung