Serological response to nifurtimox in adult patients with chronic Chagas disease: An observational comparative study in Argentina.

Nifurtimox is indicated in Chagas disease but determining its effectiveness in chronic disease is hindered by the length of time needed to demonstrate negative serological conversion. We manually reviewed long-term follow-up data from hospital records of patients with chronic Chagas disease (N = 1,497) in Argentina diagnosed during 1967-1980. All patients were aged ≥18 years at diagnosis and were either treated with nifurtimox (n = 968) or received no antitrypanosomal treatment (n = 529). The primary endpoint was negative seroconversion (the "event"), defined as a change from positive to negative in the serological or parasitological laboratory test used at diagnosis. Time to event was from baseline visit to date of endpoint event or censoring. The effectiveness of nifurtimox versus no treatment was estimated with Cox proportional hazard regression using propensity scores with overlap weights to calculate the hazard ratio and 95% confidence interval. The nifurtimox group was younger than the untreated group (mean, 32.4 vs. 40.3 years), with proportionally fewer females (47.9% vs. 60.1%), and proportionally more of the nifurtimox group than the untreated group had clinical signs and symptoms of Chagas disease at diagnosis (28.9% vs. 14.0%). Median maximum daily dose of nifurtimox was 8.0 mg/kg/day (interquartile range [IQR]: 8.0-9.0) and median treatment duration was 44 days (IQR: 1-90). Median time to event was 2.1 years (IQR: 1.0-4.5) for nifurtimox-treated and 2.4 years (IQR: 1.0-4.2) for untreated patients. Accounting for potential confounders, the estimated hazard ratio (95% confidence interval) for negative seroconversion was 2.22 (1.61-3.07) favoring nifurtimox. Variable treatment regimens and follow-up duration, and an uncommonly high rate of spontaneous negative seroconversion, complicate interpretation of this epidemiological study, but with the longest follow-up and largest cohort analyzed to date it lends weight to the benefit of nifurtimox in adults with chronic Chagas disease. Trial registration: The study protocol was registered at ClinicalTrials.gov: NCT03784391.

Implantes mamarios, eventos adversos y complicaciones poco frecuentes: hallazgos por mamografía, ecografía y resonancia magnética / Breast Implants, Adverse Events and Rare Complications: Findings by Mammography, US and MR Imaging

Introducción: En la actualidad, la mamoplastia de aumento con implantes es un procedimiento cada vez más común, con fines exclusivamente cosméticos o reconstructivos después de una mastectomía. Existen complicaciones locales ampliamente conocidas, como la ruptura y contracturas capsulares, pero también se le han atribuido otras complicaciones menos frecuentes, como el linfoma anaplásico y el síndrome autoinmune/inflamatorio inducido por adyuvantes (ASIA). Objetivo: Revisar las características por imagen de las complicaciones frecuentes e infrecuentes asociadas al aumento mamario con prótesis. Metodología: Recolección retrospectiva de casos con complicaciones relacionadas con implantes mamarios; revisión y edición de las diferentes modalidades de imágenes en pacientes de la clínica Fundación Valle del Lili de Cali durante los dos últimos años. Resultados: Es frecuente encontrar cambios postquirúrgicos por mamoplastia de aumento con implantes. Aunque la mamografía tiene un papel limitado en la valoración de las complicaciones del implante, continúa siendo la herramienta de tamizaje de cáncer en la mama aumentada. La ecografía es un instrumento muy útil y costo-efectivo en la evaluación de los implantes. La RM con secuencias de silicona es la modalidad con más alta sensibilidad y especificidad si se quiere valorar la integridad del implante y el tejido mamario en su conjunto.

Introduction: At present, breast augmentation with implants is an increasingly common procedure, be it solely for cosmetic reasons or for reconstructive purposes after mastectomy. There are widely known local complications associated with this intervention, such as implant rupture and encapsulation, but there are other less common complications too, such as anaplastic lymphoma and autoimmune/inflammatory syndrome induced by adjuvants (ASIA). Objective: To review the imaging characteristics of frequent and infrequent complications associated with breast augmentation with implants. Methodology: Cases of different complications were retrospectively collected, in order to review mammography, ultrasound, CT and MRI images of patients with such complications at the Fundación Valle del Lili Clinic (Cali, Colombia) over the past two years. Conclusions: It is common to find post-surgical changes due to breast augmentation with implants. The study concludes that although mammography has a limited role in the assessment of implant complications, it remains the main screening tool for cancer in augmented breasts. Ultrasound is a very useful and cost-effective tool in evaluating implants. MRI with silicone sequences has the highest sensitivity and specificity when assessing the integrity of the implant and breast tissue as a whole. Key words (MeSH) Breast implants Implant capsular contracture Seroma Adjuvants, immunologic

Leishmaniasis Tegumentaria Americana en la Provincia de Santiago del Estero, Argentina / American Tegumentary Leishmaniasis in the Province of Santiago del Estero, Argentina

Se estudiaron tres casos de Leishmaniasis Tegumentaria Americana (LTA) en pacientes con formas clínicas cutáneas en la provincia de Santiago del Estero, Argentina. Para el aislamiento de las cepas a partir de la lesión primaria se realizó: examen directo, cultivos e inoculación en animales receptivos. Para la tipificación de género y especie: biometría y utilización de anticuerpos monoclonales. Se realizaron exámenes serológicos de Inmunoglorescencia Indirecta y ELISA, como así mismo la aplicación de la Intradermorreacción de Montenegro (IRM), empleando antígenos diferentes. En los tres casos estudiados de cepa aislada por Leishmania Viannia braziliensis.

The autors describe a study of three patients with American Tegumentary Leishmaniasis (LTA) with cutaneous lesions in the providence of Santiago del Estero - Argenina. Direct examination, cultures and innoculation in receptive animals were performed in order to isolate the differents strains from the primary lesion, biometric studis and techniques with monoclonal antibodies in otder to know the genus and specific epithet. Serological indirect inmunofluorescence examination and ELISA, as well as the intradermal reaction of Montenegro (IRM) using different antigens. In the three examples studied the isolated strain was Leishmania Viannia braziliensis.