ESTUDIO DE LAS COINFECCIONES POR OTROS PATÓGENOS RESPIRATORIOS EN PACIENTES PEDIÁTRICOS CON DIAGNÓSTICO DE COVID-19 / STUDY OF COINFECTIONS BY OTHER PATHOGENS RESPIRATORY IN PEDIATRIC PATIENTS WITH DIAGNOSTICS FROM COVID-19

Introducción: La coinfección de COVID-19 con otros patógenos respiratorios en pediatría ha sido poco estudiada. Resulta de interés conocer las características y cuadro clínico de pacientes que presenten coinfecciones con COVID-19. Objetivo: Estudiar la coinfección de SARS-CoV-2 con patógenos incluidos en el Panel RP 2.0 FilmArray® en muestras de pacientes pediátricos en un hospital del tercer nivel. Materiales y métodos: Durante abril a agosto de 2021 se realizó un estudio prospectivo descriptivo sobre 21 muestras de Hisopado Nasofaríngeo de pacientes pediátricos positivos para SARS-CoV-2 (iAMP® COVID-19 Detection Kit de Atila Biosystems). Se procesaron por PCR multiplex Filmarray® RP 2.0. Luego se describieron las características y síntomas de los pacientes. Resultados: 12/21 (60%) fueron pacientes ambulatorios y 8/21 (40%) internados. El 57% de los pacientes fueron mayores de 5 años, el 24% menores de 1 año y el 19% entre 1 y 5 años. El síntoma más frecuente fue fiebre 18/21 (86%). El 90,5% (19/21) de las muestras no mostraron detección de otros patógenos. En una muestra se detectó Rhino/enterovirus y en otra Coronavirus NL63; ambas pertenecieron a dos pacientes con enfermedades de base. Conclusión: La tasa de coinfecciones fue del 9,5%. Este número podría deberse a la baja circulación de patógenos respiratorios en un contexto con medidas de prevención de los contagios. En el estado actual de incremento de circulación de virus respiratorios endémicos, es de interés la búsqueda de coinfecciones con COVID-19

Introduction: The co-infection of COVID-19 with other respiratory pathogens in pediatrics has been little studied. It is of interest to know the characteristics and clinical picture of patients who present co-infections with COVID-19. Objective: To study the co-infection of SARS-CoV-2 with pathogens included in the RP Panel 2.0 FilmArray® in samples from pediatric patients in a third-level hospital. Materials and methods: During April to August 2021, a prospective descriptive study was conducted on 21 Nasopharyngeal Swab samples from pediatrics patients positive for SARS-CoV-2 (iAMP® COVID-19 Detection Kit from Attila Biosystems). They were processed by PCR multiplex Filmarray® RP 2.0. The characteristics and symptoms of the patients were then described. Results: 12/21 (60%) were outpatients and 8/21 (40%) were hospitalized. 57% of patients were older than 5 years, 24% under 1 year and 19% between 1 and 5 years. The most frequent symptom was fever 18/21 (86%). 90,5% (19/21) of the samples showed no detection of other pathogens. Rhino/enterovirus was detected in one sample and NL63 in another Coronavirus; both belonged to two patients with underlying diseases. Conclusion: The rate of co-infections was 9,5%. This number could be dueto the low circulation of respiratory pathogens in a context with measures to prevent contagion. In the current state of increased circulation of endemic respiratory viruses, the search for co-infections with COVID-19 is of interest

Sexto reporte de eventos adversos con tratamientos biológicos en Argentina: Informe del registro BIOBADASAR / Sixth report of adverse events with biological treatments in Argentina: Report of the BIOBADASAR registry

Objetivo: Actualizar los resultados del registro BIOBADASAR sobre seguridad, duración y causas de interrupción del tratamiento luego de 8 años de seguimiento. Métodos: BIOBADASAR es un registro de seguridad de terapias biológicas establecido por la Sociedad Argentina de Reumatología. Se presenta la descripción de BIOBADASAR 3.0, una cohorte compuesta por 53 centros de Argentina seguidos prospectivamente desde agosto de 2010 hasta enero de 2018. Resultados: Se registraron 4656 pacientes, 6234 tratamientos [3765 casos (terapia con biológicos) y 2469 controles (terapia no biológicos)]. Se interrumpió el tratamiento en el 44,6% en los casos vs. 27,9% en los controles. Causa principal de discontinuación fue por ineficacia (40% casos vs. 32% controles). Se presentaron 3154 eventos adversos (2230 en casos vs. 924 en controles), de los cuales el 13,6% fueron graves (9,8% en casos y 3,7% en controles). El evento adverso (EA) más frecuente en ambos grupos fueron las infecciones (43,56% en casos vs. 34,31% en los controles, RR: 3,42; IC 95%: 3,02-3,88), y de ellas las de vías aéreas superiores (14,5%). Las neoplasias se presentaron en 78 casos vs. 45 en controles (RR: 1,98; IC 95%: 1,37-2,86). Conclusiones: En este sexto reporte no se observan tendencias diferentes sobre seguridad, duración y causas de interrupción del tratamiento respecto a informes previos. Las infecciones fueron el principal EA y la ineficacia, seguido por EA y la pérdida de pacientes las principales causas de suspensión del tratamiento. El advenimiento de nuevos agentes biológicos y la necesidad de control en seguridad a largo plazo, fortalece el uso de este tipo de registro.

Objective: Update the results of the BIOBADASAR registry on safety, duration and causes of treatment interruption after 8 years of follow-up. Methods: BIOBADASAR is a safety record of biological therapies established by the Argentine Society of Rheumatology. The description of BIOBADASAR 3.0 is presented, a cohort of 53 centers in Argentina followed prospectively from August 2010 to January 2018. Results: 4656 patients were registered, 6234 treatments [3765 cases (therapy with biologicals) and 2469 controls (non-biological therapy)]. Treatment was interrupted in 44.6% in cases vs. 27.9% in controls. Main cause of discontinuation was due to inefficiency (40% cases vs. 32% controls). There were 3154 adverse events (2230 in cases vs. 924 in controls), of which 13.6% were tombs (9.8% in cases and 3.7% in controls). The most frequent adverse event (AE) in both groups were infections (43.56% in cases vs. 34.31% in controls, RR: 3.42, 95% CI: 3.02-3.88), and the upper airway pathways (14.5%). Neoplasms were published in 78 cases versus 45 controls (RR: 1.98, 95% CI: 1.37-2.86). Conclusions: In this article, there are no different trends regarding safety, duration and causes of interruption of treatment compared to previous reports. Infections were the main causes of treatment discontinuation. The advent of new biological agents and the need for control over long-term security, strengthens the use of this type of registration.

Características de los tratamientos biológicos en enfermedades reumáticas en Argentina: quinto informe del registro BIOBADASAR / Features of rheumatic diseases biological treatments in Argentina: BIOBADASAR fifth report

Introducción: El proyecto BIOBADASAR (Registro argentino deeventos adversos con tratamientos biológicos en reumatología)comenzó en agosto de 2010, para recabar información a largo plazosobre los eventos adversos en tratamientos biológicos en pacientescon enfermedades reumáticas en la práctica clínica cotidiana enArgentina.Pacientes y método: Se registraron datos de cada paciente,tratamientos y acontecimientos adversos relevantes o importantes.Los pacientes debían tener enfermedad diagnosticada y tratadacon un agente biológico. Cada caso se comparó con un control:un paciente con tratamiento no biológico con característicasdemográficas similares. Se analizaron los datos con análisis de lavarianza, con test de t de Student, Mann Whitney, test chi2, o testexacto de Fisher. El análisis de supervivencia de los tratamientoshasta su discontinuación o interrupción se realizó con el método deKaplan-Meier y test log-rank...

Background: BIOBADASAR (Argentine Registry of Adverse Eventsin Biological Treatments in Rheumatology) was started in August2010 to obtain long-term information of patients with rheumatic diseases,treatments and adverse events in everyday clinical practice.Patients and methods: Data on patients’ demographics,treatments and adverse events were collected. Patients had a diagnosisof a rheumatic disease and were treated with biological agent.To compare information, a control group was included, consisting ofpatients treated with similar demographic characteristics but treatedwith a non-biological agent. Data were analysed with Anova,Student´s t, Mann Whitney, chi2, Fisher´s exact tests, as appropriate.Survival analysis of treatments was performed with Kaplan-Meiercurves and log-rank test...

Tercer reporte de eventos adversos con tratamientos biológicos en Argentina. Informe de registro biobadasar / Thrid report of adverse events with biologics in Argentina. Report from biobadasar registry

Introducción: BIOBADASAR (Registro Argentino de Eventos Adversos con Tratamientos Biológicos en Reumatología) comenzó en agosto de 2010. La importancia de este registro es mostrar datos locales que, probablemente, puedan diferir de otros registros. El objetivo es comunicar los resultados del tercer reporte de BIOBADASAR. Métodos: Todos los pacientes con enfermedades reumáticas que requirieron tratamiento con agentes biológicos y pacientes controles sin estos tratamientos fueron incluidos en la base de datos provenientes de 32 centros participando a lo largo de la Argentina. Tres áreas de datos son analizados: características de los pacientes, tratamientos y eventos adversos...

Introduction: BIOBADASAR (Argentine Registry of Adverse Events with Biological Treatments in Rheumatology) began in August 2010. The importance of this registry is to show local data that may probably differ from other registries. The objective is to communicate the results of the third BIOBADASAR report. Methods: All patients with rheumatic diseases who required treatment with biological agents and control patients without these treatments were included in the database from 32 participating centers throughout Argentina. Three areas of data are analyzed: patient characteristics, treatments and adverse events...

[Food and diabetes]. / Alimentación y diabetes.

A low glycemic diet may improve metabolic control in type 2 diabetes, but the debate continues. Fruits, despite the fructose they contain, may also lower the glycemic index, as well as its consumption has been associated with a reduction in A1c levels and can positively influence HDL cholesterol, blood pressure and risk of coronary heart disease in general. There is no relationship between fat intake and A1c. On the consumption of alcohol has been reported that moderate alcohol consumption is associated with a lower prevalence of metabolic syndrome, although there is information that relates to the A1c. This article reviews the published evidence on the effect of consumption of fruits, fats and alcohol on metabolic control in diabetics.

[Comparison between the quality of life and nutritional status of nutrition students and those of other university careers at the Santo Thomas University in Chile]. / Comparación en calidad de vida y estado nutricional entre alumnos de nutrición y dietética y de otras carreras universitarias de la Universidad Santo Tomás de Chile.

OBJECTIVE: To determine and compare the quality of life, nutritional status, and self-perceived body image between nutrition students and students from other careers from the University Santo Tomás-Viña del Mar. METHODS: We evaluated 200 student volunteers (100 nutrition students and 100 students from other careers) with a quality of life survey, a nutritional evaluation, and a survey of body image perception. RESULTS: The group of nutritional students perceived a lower quality of life, consumed less tobacco, and was less sedentary. Women of the nutritional group had a lower BMI and showed a lower hip circumference. Men of the nutritional group also showed a lower hip circumference. The nutritional group consumed more milk, chicken, and fish in their diet. Both groups presented an elevated consumption of alcohol. The concordance between BMI and body image was low, 34% in the nutritional group and 38% in the other careers group (Kappa 0.04 and 0.02). CONCLUSION: With respect to perception of quality of life, students from other careers perceived a better quality of life, however students from the nutritional group presented better nutritional status and selection of food.

Manifestaciones clínicas y bioquímicas asociadas a infección por virus del dengue en pacientes con enfermedades reumáticas durante un brote epidémico en la provincia de Catamarca, República Argentina / Clinical and biochemical manifestations associated to infection by dengue virus in patients with rheumatic diseases turing and epidemic outbreak in Catamarca, Argentine Republic

Introducción: Durante el año 2009 hubo en Argentina un brote epidémico de infección por virus del dengue (IVD). Los factores del huésped (comorbilidades, inmunosupresión, otros), el sistema inmune y la virulencia del virus determinan la fisiopatogenia y su expresividad clínica. Objetivos: Describir las manifestaciones clínicas y bioquímicas de pacientes con enfermedades reumatológicas (ER) en las etapas previa, durante y post IVD. Material y métodos: Durante febrero-mayo de 2009 se realizó un estudio observacional, en el que se incluyeron pacientes consecutivos con ER e IVD. Se registraron datos: demográficos, clínicos, bioquímicos, impresión global de actividad de la ER y tratamientos farmacológicos. Resultados: Se incluyeron 11 pacientes (9 mujeres) de los cuales 6 tenían artritis reumatoidea, 2 lupus eritematoso sistémico, y 1 artritis psoriásica, dermatopolimiositis, y espondilitis anquilosante, respectivamente. La edad promedio fue de 47 años. Al inicio de la IVD, todos los pacientes presentaron fiebre y cefalea, y 90% leucopenia. Una paciente con LES cambió su estado clínico durante la IVD. No se registraron formas graves de IVD, pero un paciente tuvo hepatitis autolimitada. Los glucocorticoides como la hidroxicloroquina no fueron suspendidos. Conclusiones: Nuestros pacientes con ER e IVD presentaron manifestaciones clínicas correspondientes a dengue clásico febril con evolución favorable.

Primer reporte de eventos adversos de tratamientos biológicos en Argentina. Informe de Registro BIOBADASAR / First report of adverse events for biologic treatments in Argentine. BIOBADASAR Register

Introducción: En la actualidad existe gran cantidad de pacientes sometidos a tratamiento con agentes biológicos en enfermedades reumatológicas y se desconocen los efectos adversos predominantes, así como la eficacia y tasa de discontinuación de nuestros pacientes en dichos tratamientos. Objetivo: Comunicar los primeros resultados de BIOBADASAR, Registro Argentino de Acontecimientos Adversos ocasionados por el Uso de Agentes Biológicos en Reumatología. Métodos: Participan del registro 56 centros de Reumatología de Argentina. Se requiere el ingreso de un paciente no tratado con agentes biológicos por cada paciente expuesto ingresado en el registro. Datosdesde el 1 de agosto de 2010 hasta 1 abril 2011. Las variables categóricasse calcularon con chi cuadrado y las continuas con T student. Se calcularon porcentajes de incidencia y por persona/año. Resultados: Se incorporaron 966 pacientes (1132 tratamientos). Mujeres 763 (79%) y hombres 203 (21%). La edad media fue 52 años (3-88); 543 pacientes (56%) fueron tratados con agentes biológicos (casos) y 423 (44%) fueron no tratados con agentes biológicos (controles). 786 pacientes tenían artritis reumatoidea (81,4%) y 79 artritis psoriásica (8,2%), entre otros diagnósticos. La media de tiempo de evolución de enfermedad fue 11 años para los casos y 8,25 años para los controles. El fármaco biológico más utilizado fue el etanercept con 348 tratamientos (50%) y una supervivencia al tratamiento en años cuya media fue 2,90 seguido por el adalimumab con 158 tratamientos (22,7%) y una supervivencia al tratamiento en años cuya media fue 2,15. La causa más frecuente de interrupción de tratamiento en los casos fue ineficacia (42,1%) seguido por eventos adversos (32%).

Metabolic syndrome in Argentinean patients with systemic lupus erythematosus.

The objective was to determine the prevalence of the metabolic syndrome (MS) in patients with systemic lupus erythematosus (SLE) in Argentina, to assess the factors associated to it, and to compare the results with a control group with non-inflammatory disorders. The study included 147 patients with SLE and 119 controls. MS was defined according to criteria by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) Scientific Statement. Demographic characteristics, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) were assessed as well as administration, maximum dose and cumulative dose of prednisone and hydroxychloroquine (HCQ). MS prevalence was 28.6% (CI 95%: 21.4-36.6) in patients with SLE and 16% in controls (P = 0.0019). Patients with SLE presented higher arterial hypertension frequency compared with controls (43 vs 25%, P = 0.007). When comparing lupus patients with MS (n = 41) and without MS (n = 106), no significant differences were observed regarding duration of the disease, SLEDAI or cumulative prednisone dose. Cumulative damage was associated independently with MS (OR 1.98; P = 0.021), whereas HCQ use was found to be protective (OR 0.13; P = 0.015). Patients with lupus presented higher MS prevalence than controls with non-inflammatory disorders, and occurrence of arterial hypertension was also higher. MS was associated with cumulative damage; the use of HCQ showed to be protective against presence of MS.

Carbunco meníngeo y cutáneo en una región agrícola / Meningeal and cutaneous carbuncle in an agricultural region

Se presentan 5 casos de ántrax (carbunco) con inoculación cutánea. Todos tenían el antecedente epidemiológico de haber trabajo reciente en un vacuno muerto por causa desconocida, con el objeto de quitar y preservar el cuero animal. En el primer caso de los dos descritos con detalles, el paciente ingresó con un síndrome infeccioso grave y severo compromiso de conciencia. A pesar que los signos meníngeos eran negativos, se demostró una meningitis hemorrágica, con grandes bacilos visibles aun sin tinciones en el examen citoquímico del LCR. La tinción de Gram y las características de cultivo fueron compatibles con B. anthracis. A su ingreso, el paciente tenía sólo dos pequeñas lesiones de la piel, lo que contrastaba con la gravedad del cuadro clínico. Todos los demás casos presentaban lesiones de la piel más notables, pero cerradas, lo que no permitió tomar muestras bacteriológicas. A su ingreso estaban afebriles, pero dos pacientes presentaron un compromiso sistémico progresivo en los primeros días, a pesar del tratamiento antibiótico adecuado, y uno de ellos falleció. El examen postmortem fue enteramente compatible con ántrax diseminado, pero no se encontraron bacilos. Se atribuye esta progresión inicial de los síntomas a la acción de la toxina del agente infeccioso

Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial.

OBJECTIVE: To identify risk factors for polymicrobial bloodstream infections (BSIs) in neonatal intensive care unit (NICU) patients during an outbreak of BSIs. DESIGN: During an outbreak of BSIs, we conducted a retrospective cohort study, assessed NICU infection control practices and patient exposure to NICU healthcare workers (HCWs), and obtained cultures of the environment and HCW hands. PATIENTS: During the period May 3 to 7, 1996, 5 infants contracted BSIs caused by both Enterobacter cloacae and Pseudomonas aeruginosa, and one infant contracted a BSI caused by E cloacae only. For each pathogen, all isolates were identical on DNA typing. RESULTS: Infants exposed to the following were more likely than nonexposed infants to have BSI: umbilical venous catheters (6/14 vs 0/7, P = .05), total parenteral nutrition given simultaneously with a dextrose/electrolyte solution (6/12 vs 0/9, P = .02), or one HCW (5/7 vs 1/13, P = .007). Neither environmental nor HCW hand cultures yielded the outbreak pathogens. Quality control cultures of intravenous solution bags were negative. CONCLUSIONS: We speculate that a dextrose multidose vial became contaminated during manipulation or needle puncture and that successive use of this contaminated vial for multiple patients may have been responsible for BSIs. Aseptic techniques must be employed when multidose vial medications are used. Single-dose vials should be used for parenteral additives whenever possible to reduce the risk of extrinsic contamination and subsequent transmission of nosocomial pathogens.

Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners.

BACKGROUND: Acinetobacter spp. are multidrug-resistant bacteria that grow well in water and cause infections with unexplained, increased summer prevalence. In August, 1996, eight infants acquired Acinetobacter spp. bloodstream infection (A-BSI) while in a nursery in the Bahamas; three infants died and an investigation was initiated. METHODS: A case patient was defined as any newborn in the nursery during August 6 to 13, 1996, with A-BSI. To identify risk factors for A-BSI we conducted a retrospective cohort study and performed environmental cultures and air sampling using settle plates. The genetic relatedness of environmental isolates was assessed by pulsed field gel electrophoresis. RESULTS: Of 33 patients in the nursery 8 (24%) met the case definition. Patients with peripheral iv catheters were more likely to develop A-BSI (8 of 21 vs. O of 10, P < 0.05). Multivariate analysis among patients with iv catheters indicated that only exposure to one nurse was an independent risk factor for developing A-BSI (P < 0.005). Nursery settle plates were more likely to grow Acinetobacter spp. than were settle plates from other hospital areas (8 of 9 vs. 0 of 5, P < 0.005); cultures from nursery air conditioners also grew Acinetobacter spp. Environmental isolates were genetically diverse. After installation of a new air conditioner in May, 1995, A-BSIs occurred more frequently during months of increased absolute humidity or environmental dew point. CONCLUSIONS: Acinetobacter spp. may cause nosocomial BSI and death among infants during periods of polyclonal airborne dissemination; breaks in aseptic technique during i.v. medication administration may facilitate transmission from the environment to the patient. Environmental conditions that increase air conditioner condensate may predispose to airborne dissemination via contaminated aerosols and increase the risk of nosocomial A-BSI.

Report on an outbreak of postinjection abscesses due to Mycobacterium abscessus, including management with surgery and clarithromycin therapy and comparison of strains by random amplified polymorphic DNA polymerase chain reaction.

An outbreak of postinjection abscesses occurred in Barranquilla, Colombia, and was associated with local injections of lidocaine given in a single physician's office. Over a 5-month period, 350 (18%) of approximately 2,000 injected patients developed localized cutaneous abscesses or cellulitis; of 210 abscess specimens that were cultured, 205 were positive for rapidly growing mycobacteria, subsequently identified as Mycobacterium abscessus. The source of the outbreak was not identified. M. abscessus could not be characterized by pulsed-field gel electrophoresis, but all isolates were identical in terms of drug and heavy metal resistance patterns and random amplified polymorphic DNA PCR profiles. We believe this is the first report of the use of this latter technique for investigation of an outbreak due to M. abscessus. Therapy with a combination of surgical excision and 3-6 months' administration of clarithromycin was successful for 95% of 148 patients treated in this manner; in contrast, therapy was successful for less than one-third of patients treated with surgery alone or clarithromycin alone. This is the largest of the nine known outbreaks of postinjection abscesses that have occurred due to rapidly growing mycobacteria and is the first in which an effective method of therapy was demonstrated.

Ectopic geographic tongue and AIDS.

A 23-year-old man with AIDS developed a lesion with the clinical characteristics of an ectopic geographic tongue in the lower lip, near the right commissure.

Treatment of aphthae with thalidomide.

We report our experience in the treatment of major and minor aphthae with thalidomide. With doses of 100 to 300 mg daily for 3 months, a cure was obtained in 34% of cases, and marked improvement was evident in the rest. The follow-up period varied from 1 to 8 years. Two patients experienced dysesthesias, which disappeared when the medication was stopped. Thalidomide cannot be prescribed to women of childbearing potential because of its teratogenic potential.