"Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach".

BACKGROUND: The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. METHODS: This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. RESULTS: Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. CONCLUSIONS: Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.

El rol del comité nacional asesor de ética en investigación como parte del sistema de investigaciones para la salud / The role of the national research ethics advisory committee as part of the health research system

En las investigaciones donde participan seres humanos, la exposición a riesgos obliga a contar con herramientas que permitan al Estado garantizar la protección de derechos de esos participantes. El Comité Nacional Asesor de Ética en Investigación asesorará al Ministerio de Salud y proporcionará directrices para establecer las pautas éticas en investigación, como parte fundamental de un Sistema Nacional de investigaciones para la Salud.

Aplicación del Examen Clínico Objetivo Estructurado en la residencia de Pediatría de la Ciudad de Buenos Aires / The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires

Introducción: A pesar de considerarse el estándar de oro para la evaluación de competencias en posgrado, el Examen Clínico Objetivo Estructurado (ECOE) es escasamente aplicado en América Latina. El Gobierno de la Ciudad de Buenos Aires (GCBA) posee un sistema de residencia de Pediatría con cerca de 400 residentes, distribuidos en 13 hospitales, que comparten examen de ingreso y programa de formación. Nuestro objetivo es describir la experiencia de aplicación del ECOE a todos los residentes de Pediatría del GCBA, y comparar el desempeño según el tipo de hospital. Sujetos y método: Estudio descriptivo, incluyendo a todos los residentes de Pediatría del GCBA que finalizaban primer año, pertenecientes a 13 hospitales (2 pediátricos y 11 generales). El ECOE incluyó 10 estaciones. Resultados: Participaron 85 residentes; el 88,2% (IC 95% 79,7-93,5) aprobó la evaluación. No se encontraron diferencias significativas en la proporción de residentes que aprobó la evaluación entre los que provenían de hospitales pediátricos y los de hospitales generales (89,5 vs. 85,7%; OR = 1,4; IC 95% 0,4-5,5; p = 0,8). Conclusiones: En 2015 por primera vez se desarrolló un ECOE como evaluación unificada para todos los residentes de Pediatría del GCBA. La experiencia permitió identificar debilidades de cada evaluado y del sistema, estableciendo estrategias para superarlas.

Introduction: The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. Subjects and method: Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. Results: Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR = 1.4; 95% CI 0.4-5.5; P = .8). Conclusions: In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them.

[Correlation between results of the residency admission test and of pediatric certification test in Buenos Aires, Argentina]. / Relación entre el desempeño en el examen de ingreso a la residencia y en el de especialización en pediatría en la Ciudad de Buenos Aires.

In the city of Buenos Aires (CABA), pediatric residents enter the residency program after taking a unified admission test. After completion of the program and passing a final test, the Universidad de Buenos Aires (UBA) provides a professional certification. The objective of this study is to determine if the results obtained in the residency admission test (RAT) and those of the professional certification test (PCT) correlated. This is a cross-sectional study, that included all subjects who passed the pediatrics RAT in CABA in 2004-2009, and that attended the pediatric PCT of the UBA. The score for each subject in both tests was obtained and the corresponding correlation was calculated. Results were divided in quintiles, and the proportion of subjects who improved their position in the PCT with respect to the RAT was calculated. Data from 303 subjects was obtained. The RAT showed a median of 45.0 (over 60 maximum) (IC-range: 43.0-48.7), and the PCT showed a median of 6 points (over 10 max.)(IC-range: 6-8). A significative correlation between results in RAT and PCT was observed (r = 0.37, p < 0.001). Based on their position in the RAT, 43.8% of subjects improved their position in the PCT, without differences between residents attending pediatric and general hospitals (45.6 vs. 31.5%; p = 0.1). In the case of pediatric residents, results of the residency admission test correlate with those obtained in the professional certification test.

[The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires]. / Aplicación del Examen Clínico Objetivo Estructurado en la residencia de Pediatría de la Ciudad de Buenos Aires.

INTRODUCTION: The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. SUBJECTS AND METHOD: Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. RESULTS: Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR=1.4; 95% CI 0.4-5.5; P=.8). CONCLUSIONS: In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them.

La investigación científica en las instituciones de salud del Gobierno de la Ciudad de Buenos Aires / Scientific research in public health institutions of the City of Buenos Aires

Los hospitales con mayor actividad académica brindan mejor atención a sus pacientes. El Gobierno de la Ciudad de Buenos Aires (GCBA) posee una extensa red de establecimientos de salud, pero existe poca información sobre su producción científica. Nuestro objetivo fue estimar la proporción de artículos científicos en MEDLINE originados en hospitales del GCBA, evaluar la contribución de cada hospital, comparar el desempeño en relación al país y describir algunas características de los artículos. Es un estudio transversal por búsqueda en MEDLINE, incorporando el nombre de cada uno de los 33 hospitales del GCBA en el campo "affiliation". Sobre más de 22 millones de citas, 1781 correspondían a hospitales del GCBA (4.4% de las citas argentinas), 66.5% se encontraban en inglés, 83.7% se referían a humanos, 30.1% eran de los últimos 5 años, 8.3% correspondía a investigaciones con alto nivel de evidencia científica (ensayos clínicos y meta-análisis) y 31.1% a investigaciones que incluían niños. En comparación con el resto de la producción nacional, las citas del GCBA incluyen menos trabajos en inglés (66.5% vs. 90.0%; OR: 0.22; p < 0.0001), menos trabajos recientes (30.1% vs. 34.6%; OR: 0.81; p < 0.0001), más investigaciones en humanos (83.7% vs. 37.3%; OR: 8.65; p < 0.0001), más ensayos clínicos (8.0% vs. 2.8%; OR: 2.9; p < 0.0001) y más investigación en niños (31.1% vs. 9.2%; OR: 4.44; p < 0.0001). Los hospitales del GCBA aportaron 4.4% del total de citas atribuidas a la Argentina en MEDLINE. Las referencias de instituciones del GCBA incluyen más ensayos clínicos e investigación en niños, y son menos recientes.

Hospitals with academic activities offer better services to their patients. The Government of Buenos Aires City (GBAC) has an important network of health facilities, but there is little information regarding their academic activities. Our aim was to estimate the proportion of articles included in MEDLINE originated in GBAC hospitals, to evaluate their contribution regarding the whole country (Argentina), and to describe some characteristics of these papers. It is a cross-sectional study based on a MEDLINE search, using the name of each of the 33 GBAC hospitals in the "affiliation" field. Among 22 million references, 1781 belonged to GBAC hospitals (4.4% of all references from Argentina); 66.5% were in English, 83.7% were related to humans, 30.1% were from the last 5 years, 8.3% included high level scientific evidence research (meta-analysis or randomized controlled trials), and 31.1% included research in children. Regarding the rest of the references from Argentina, those from GBAC hospitals included less papers in English (66.5% vs. 90.0%; OR: 0.22; p < 0.0001), less recent papers (30.1% vs. 34.6%; OR: 0.81; p < 0.0001), more research in humans (83.7% vs. 37.3%; OR: 8.65; p < 0.0001), more randomized controlled trials (8.0% vs. 2.8%; OR: 2,9; p < 0.0001), and more research in children (31.1% vs. 9.2%; OR: 4.44; p < 0.0001). GBAC hospitals contributed with 4.4% of references attributed to Argentina in MEDLINE. References from GBAC hospitals were less recent, and included more randomized controlled trials and research in children.

La investigación científica en las instituciones de salud del Gobierno de la Ciudad de Buenos Aires / Scientific research in public health institutions of the City of Buenos Aires

Los hospitales con mayor actividad académica brindan mejor atención a sus pacientes. El Gobierno de la Ciudad de Buenos Aires (GCBA) posee una extensa red de establecimientos de salud, pero existe poca información sobre su producción científica. Nuestro objetivo fue estimar la proporción de artículos científicos en MEDLINE originados en hospitales del GCBA, evaluar la contribución de cada hospital, comparar el desempeño en relación al país y describir algunas características de los artículos. Es un estudio transversal por búsqueda en MEDLINE, incorporando el nombre de cada uno de los 33 hospitales del GCBA en el campo "affiliation". Sobre más de 22 millones de citas, 1781 correspondían a hospitales del GCBA (4.4% de las citas argentinas), 66.5% se encontraban en inglés, 83.7% se referían a humanos, 30.1% eran de los últimos 5 años, 8.3% correspondía a investigaciones con alto nivel de evidencia científica (ensayos clínicos y meta-análisis) y 31.1% a investigaciones que incluían niños. En comparación con el resto de la producción nacional, las citas del GCBA incluyen menos trabajos en inglés (66.5% vs. 90.0%; OR: 0.22; p < 0.0001), menos trabajos recientes (30.1% vs. 34.6%; OR: 0.81; p < 0.0001), más investigaciones en humanos (83.7% vs. 37.3%; OR: 8.65; p < 0.0001), más ensayos clínicos (8.0% vs. 2.8%; OR: 2.9; p < 0.0001) y más investigación en niños (31.1% vs. 9.2%; OR: 4.44; p < 0.0001). Los hospitales del GCBA aportaron 4.4% del total de citas atribuidas a la Argentina en MEDLINE. Las referencias de instituciones del GCBA incluyen más ensayos clínicos e investigación en niños, y son menos recientes.(AU)

Hospitals with academic activities offer better services to their patients. The Government of Buenos Aires City (GBAC) has an important network of health facilities, but there is little information regarding their academic activities. Our aim was to estimate the proportion of articles included in MEDLINE originated in GBAC hospitals, to evaluate their contribution regarding the whole country (Argentina), and to describe some characteristics of these papers. It is a cross-sectional study based on a MEDLINE search, using the name of each of the 33 GBAC hospitals in the "affiliation" field. Among 22 million references, 1781 belonged to GBAC hospitals (4.4% of all references from Argentina); 66.5% were in English, 83.7% were related to humans, 30.1% were from the last 5 years, 8.3% included high level scientific evidence research (meta-analysis or randomized controlled trials), and 31.1% included research in children. Regarding the rest of the references from Argentina, those from GBAC hospitals included less papers in English (66.5% vs. 90.0%; OR: 0.22; p < 0.0001), less recent papers (30.1% vs. 34.6%; OR: 0.81; p < 0.0001), more research in humans (83.7% vs. 37.3%; OR: 8.65; p < 0.0001), more randomized controlled trials (8.0% vs. 2.8%; OR: 2,9; p < 0.0001), and more research in children (31.1% vs. 9.2%; OR: 4.44; p < 0.0001). GBAC hospitals contributed with 4.4% of references attributed to Argentina in MEDLINE. References from GBAC hospitals were less recent, and included more randomized controlled trials and research in children.(AU)

Estudio descriptivo cualitativo acerca del conocimiento entre los investigadores locales de las pautas para la integridad en la investigación / Descriptive qualitative study on knowledge about research integrity guidelines among local researchers

INTRODUCCIÓN La investigación científica se basa en la confianza. Los investigadores pueden incurrir en malas conductas, que debilitan la credibilidad. OBJETIVOS Describir y comparar el conocimiento y la valoración de patrones de conducta responsable entre investigadores de la Ciudad Autónoma de Buenos Aires (CABA) según sexo, edad e institución. Describir la frecuencia y el conocimiento de conductas irresponsables entre los investigadores. MÉTODOS Se realizó una encuesta a investigadores de CABA, en las que se solicitó opinión sobre la situación imaginaria de conductas irresponsables. Las variables demográficas fueron edad, sexo, antigüedad y cargo como profesional y como investigador. Las variables de la encuesta fueron ordinales y numerales, con sólo dos campos abiertos. RESULTADOS Con N=86, el 99% consideró que la falsificación de datos debilita la credibilidad en la investigación, el 20% dijo que era habitual y el 76%, poco frecuente. El 93% reconoció el plagio y su significado, el 80% lo calificó como muy grave y el 48% lo consideró habitual. Para el 92%, la incorrecta asignación de créditos era de grave a muy grave, el 62% la consideró habitual, el 52% dijo que se había visto involucrado en una situación como la descripta y el 93% señaló que era de frecuente a muy frecuente. En cuanto al conflicto de intereses, el 87% consideró que debe declararse la práctica privada en el ámbito público y el 89% eligió al comité de ética en investigación como el ámbito propicio para realizar la declaración. DISCUSIÓN Se conoce y percibe la gravedad de las áreas proclives a la mala conducta en investigación. Se requieren cambios culturales y procedimientos que permitan reconocerla, denunciarla y solucionarla.

La mujer médica en el Sistema Público de Salud del GCABA: La cuestión de género y su influencia en la carrera profesional / The medical woman in the Public Health System of the GCABA: The gender issue and its influence on the professional career

El trabajo que se presenta es el resultado de una investigación desarrollada en la Ciudad de Buenos Aires durante los años 2010/2011. Enmarcada en la perspectiva de género el estudio indagó sobre las formas de participación de las mujeres médicas en el sistema de salud. Tomando como antecedente los estudios de género se entienden las condiciones sociales y laborales de las mujeres como resultado de una construcción histórica, cultural, ideológica, económica y política. En tal sentido, desde esta perspectiva se propone una mirada crítica de los procesos analizados aludiendo a las relaciones de poder, las jerarquías, la división social y sexual del trabajo, al manejo del poder en ámbitos laborales y profesionales vinculados a los condicionamientos socio-económicos-culturales de las sociedades. Desde esta perspectiva la investigación recorrió los siguientes interrogantes: ¿Qué motiva a las mujeres médicas a ingresar y permanecer en el sistema?¿Cómo perciben las relaciones de género, de poder y la llegada a cargos de conducción?¿Qué expectativas de acceder a cargos de conducción tienen las mujeres médicas? ¿Cómo influye la vida familiar en la formación y desarrollo profesional de las mujeres médicas?. Para esto, se dividió el trabajo de investigación en dos problemas científicos: ¿Cuales son las razones que las mujeres médicas que trabajan en el área de salud del GCBA en la actualidad esgrimen como importantes al momento de decidir trabajar en el ámbito público?¿Cuales son los factores que dificultan el acceso de las mujeres médicas que trabajan en el área de salud del GCBA en la actualidad a cargos de conducción tanto en el nivel central como en el sector hospitalario?.(AU)

Prevalencia de papilomavirus humano (HPV) tipo 6, 11, 16 y 18 en la ciudad de Buenos Aires: implicancias en la implementación de vacunas profilácticas / Prevalence of human papillomavirus (HPV-6-11, -16 and -18) in the city of Buenos Aires: epidemiology and vaccination

Introducción: el cáncer cervical es uno de los cáncer más comunes que afectan mujeres en países en desarrollo. Es provocado por la infección persistente del Papilomavirus Humano (HPV). En los últimos años se ha lanzado al mercado una vacuna cuadrivalente contra los HPV de bajo y alto riesgo (HPV-6, 11, 16 y 18), otra vacuna, bivalente para HPV-16 y 18, también ha sido introducida al mercado. En el presente trabajo se evaluó si los tipos de HPV cubiertos por las vacunas profilácticas son los más prevalentes en nuestro país, así como la utilidad de los métodos de detección viral por ADN como herramienta para el diagnóstico en mujeres asintomáticas. Materiales y métodos: éste protocolo se encuentra aprobado por el Comité de Docencia e Investigación (CODEI) del Hospital Gral. de Agudos "C.G. Durand" y por el consejo de Etica de la USAL. Todos los participantes dieron consentimiento escrito voluntario antes de participar del mismo. Se analizaron biopsias cervicales obtenidas en el Servicio de Tocoginecología de dicho Hospital, las cuales fueron agrupadas en 4 categorías: Grupo Control (ctrl.) n= 27, Grupo de lesiones de bajo grado (CIN I) n = 22, Grupo de lesiones de mediano y alto grado (CIN II/III) n = 30, Grupo de carcinomas cervicales (CC) n = 35. El ADN fue extraído por métodos estándar. La determinación de presencia de HPV se realizó mediante PCR específica con cebadores MY09/MY11. La tipificación de ADN específico de HPV-6, -11, -16 y -18 se realizó con PCR multiplex específica. Resultados y conclusiones: hemos observado una alta incidencia de la infección con HPV-16 en todos los grupos analizados (52% p< 0,0001), y varias muestras mostraron coinfección entre HPVs de alto riesgo, y entre HPVs de bajo y alto riesgo (6,85%, p< 0,001 vs. HPV16). Estos resultados, sumados al hecho que el 17,8 % de las muestras no mostró infección con los citados tipos de HPV, sugieren que la prevalencia de los tipos virales cubiertos por las vacunas es menor a la esperada...

Introductions: Cervical cancer is one of the most frequent cancers that affect women in developing countries. It is caused by persistent infection with Human Papillomavirus (HPV). In the last years a cuadrivalent vaccine against High-risk HPVs (HPV-6, -11, -16 and -18) has been launched into the market; another vaccine, bivalent for HPV-16 and -18, has also been introduced intro the market. In the present work we evaluated if HPV types covered by these vaccines are actually the most prevalent in our country, as well as the utility of DNA-based viral detection essays as a diagnosis tool in asymptomatic women. Materials and Methods: this protocol has been approved by the Hospital Durand's Teaching and Ethics committee (CODEI) and by the Ethics committee of USAL. All pariticipants gave voluntary informed consent before being included in the study. we analyzed cervical biopsies obtained in Gynecology Service of Hospital Durand, which were grouped into 4 categories: Control group (ctrl.) n = 27, low grade cervical lesions group (CIN I) n = 22, high grade cervical lesions group (CIN II/III) n = 30, cervical carcinomas (CC) n = 35. DNA was extracted by standard methods. Viral HPV presence was evaluated by specific PCR with MY09/MY11 primers. Viral-specific DNA determination of HPV-6, -11, -16 and -18 was evaluated by specific multiplex PCR. Results and conclusions: We observed a high incidence of and several samples showd co-infection between High-risk HPVs, and between high and low-risk HPVs (6.85%, p< 0.001 vs. HPV16). These results, plus the fact that almost 17.8% of the samples shown no expression of HPV types covered by the vaccines, suggest that the prevalence of HPV-6,-11, -16 and -18 is lower than expected in Buenos Aires city.

Expresión de oncogenes y estado de integración del Papilomavirus Humano (HPV) como posibles marcadores de progresión maligna en pacientes con lesiones cervicales: estudio preliminar en la ciudad de Buenos Aires / Viral oncogene expression and integration status of the human papillomavirus as possible markers of malignant progression in patients with cervical lesions

Introducción: el Papilomavirus Humano (HPV) ha sido identificado como agente causal del cáncer cervical, induciendo lesiones cervicales de bajo grado que, eventualmente, se malignizan debido a distintos factores. La expresión de oncogenes virales y el estado de integración viral son necesarios para el desarrollo de neoplasias, por lo que podrían utilizarse como marcadores de progresión maligna en éste tipo de lesiones. Objetivo: evaluar la expresión de los oncogenes virales E6/E7 de HPV16 y 18 y el estado del genoma viral como posibles marcadores de progresión maligna. Materiales y métodos: se evaluaron muestras de lesiones cervicales (n = 27 controles (Ctrl), n = 18 CIN I, n= 24 CIN II/III y n = 32 Carcinomas invasivos (CC) derivadas del Hospital Gral. de Agudos C. Durand, CABA. Se evaluó la presencia de genoma consenso HPV y específico HPV16 y 18 mediante dPCR. Se determinó la expresión de oncogenes virales E6/E7 de HPV16 y HPV 18 y el estado de integración viral se analizó mediante PCR-APOT. Resultados: se observó un aumento significativo de presencia de genoma viral en correlación con el grado de lesión analizada CIN I: 77,8 %, CIN II/III: 83,3 % y CC: 100 % en comparación con el grupo control (25,9 %, p<0,001). La infección con HPV16 fue significativamente mayor en todos los grupos (vs. HPV18, p<0,001), encontrándose coinfección en varios casos. La expresión de los oncogenes virales de HPV16 fue significativamente mayor en comparación con HPV18 (p<0,0001). El estado físico de los genomas virales mostró una tendencia a la forma integrada en correlación con el grado de lesión analizada, encontrándose mayor presencia de genomas integrados en CC (vs. Episomal y/o episomal e integrado p<0,02) de HPV16. Para HPV18, sólo pudimos observar genomas integrados en CIN II/III (100 %) y CC (50 %). Sólo el 12,5 % de los genomas HPV 18 fueron detectados episomal e integrado. Conclusiones: observamos altas frecuencias de infección con HPV16 en comparación con HPV 18...

Introduction: Human Papillomavirus (HPV) has been identified as causal agent of cervical cancer, inducing cervical low grade lesions that, eventually, maligniza due to different factors. Viral oncogene expression and integration status are necessary for neoplasic development, and they could be used as malignant progression markers in these types of lesions. Aim: Evaluate HPV16 and 18 (E6/E7) viral oncogene expression and genome integration status as possible malignant progression markers. Materials and methods: Cervical samples derived from Hospital GA C. Durand (CABA) were evaluated (n = 27 healthy controls -Ctrl-, n = 18 CINI, n = 24 CIN II/III abd b = 32 Invasive Carcinomas (CC). HPV consensus and HPV16 and 18 specific genomes were evaluated by PCR. Viral oncogene expression (E6/E7) of HPV16 and HPV18 was determined, as well as viral integration status was determined by means of PCR-APOT. Results: A significant increase in viral genome presence was observed in correlation with the degree of the lesion analyzed CIN I: 77,9%, CIN II/III: 83,3% y CC: 100% in comparison to control Group (25,9% p<0,001). The infection with HPV16 was significantly greater in all the groups in comparison with HPV18 (p<0,001); co-infection was detected in several cases. HPV 16 oncogene expression was greater than the one showed by HPV-18 (p<0,0001). The physcal state of the viral genomes showed a tendency to the integrated form in correlation with the degree of analyzed lesion, detecting most of integrated HPV16 genomes in CC group (vs. episomal and/or episomal and integrated, p<0,02), FORM II/III (100%) and CC (50%). Only a minor fraction of HPV18 genomes in CC where found to be, both, episomal and integrated (12,5%). Conclusions: We have detected higher HPV16 infection frequencies in comparison with HPV18 in all analyzed groups. On the other hand, we observed an increase in HPV-16 onocogene expression in comparison to HPV18 ones. HPV16 was found predominantly integrated...

Respiratory infections in immunocompromised patients.

PURPOSE OF REVIEW: Immunosuppressive states and therapies are becoming common in clinical practice. Recent advances and trends in bacterial, fungal, viral and parasitic pulmonary infections in immunosuppressed patients are described. RECENT FINDINGS: Pulmonary infections can jeopardize the prognosis of immunosuppressed patients. The number of patients infected with multidrug-resistant bacteria or opportunistic pathogens like rapid-growing environmental mycobacteria, Strongyloides stercoralis or Rhodococcus equi is increasing with the increased numbers of immunosuppressed patients due to HIV/AIDS and the potent immunosuppressive therapies used in solid-organ and haematopoietic transplantations, cancer and systemic illnesses. The slow development of more effective antibiotics underlines the necessity of preventive measures, development of rapid detection tests for pathogens and appropriate treatment regimens to avoid development of further resistance. SUMMARY: Adequate prophylaxis, clinical suspicion, microbiological and molecular investigations, drug susceptibility-based antibiotic treatment and new drug development are strategies required to face up to the challenge of pulmonary infections in immunodepressed patients.

Association of DRB1 and DQB1 HLA class II polymorphisms in high-grade and neoplastic cervical lesions of women from Argentina.

OBJECTIVES: To investigate associations between HLA-DRB1 and HLA-DQB1 polymorphisms with low- and high-grade cervical lesions in Argentine population and the role human papillomavirus status in these associations. MATERIALS AND METHODS: Cervical biopsies and peripheral blood samples were taken from 32 patients with cervical intraepithelial neoplasia grade 1 (CIN 1) and 44 patients with cervical CIN 3 or invasive squamous cell carcinomas. Cervical cells and peripheral blood samples from 40 healthy women were included as control group. Human papillomavirus detection and typing were done by polymerase chain reaction (PCR) MY09, 11-restriction fragment length polymorphisms, or PCR 5+, 6+ dot-blot hybridization, and HLA DR/DQ typing by the PCR-sequence-specific oligonucleotide probes method. RESULTS: HLA-DRB1*04 and HLA-DQB1*0302 were found to be positive associated with the CIN 3/invasive squamous cell carcinomas subgroup, whereas HLA-DRB1*13 and HLA-DQB1*02 were negatively associated with the same group, when comparing to the control group. CONCLUSIONS: The data support the hypothesis that HLA-DRB1*04 and HLA-DQB1*0302 may be considered risk factors for malignant progression, whereas HLA-DRB1*13 and HLA-DQB1*02 may have a protective role. Further studies with a larger group are needed to confirm these susceptibility and protective roles in disease progression in Argentine population.

Detection of human papillomavirus DNA and p53 codon 72 polymorphism in prostate carcinomas of patients from Argentina.

BACKGROUND: Infections with high-risk human papillomaviruses (HPVs), causatively linked to cervical cancer, might also play a role in the development of prostate cancer. Furthermore, the polymorphism at codon 72 (encoding either arginine or proline) of the p53 tumor-suppressor gene is discussed as a possible determinant for cancer risk. The HPV E6 oncoprotein induces degradation of the p53 protein. The aim of this study was to analyse prostate carcinomas and hyperplasias of patients from Argentina for the presence of HPV DNA and the p53 codon 72 polymorphism genotype. METHODS: HPV DNA detection and typing were done by consensus L1 and type-specific PCR assays, respectively, and Southern blot hybridizations. Genotyping of p53 codon 72 polymorphism was performed both by allele specific primer PCRs and PCR-RFLP (Bsh1236I). Fischer's test with Woolf's approximation was used for statistical analysis. RESULTS: HPV DNA was detected in 17 out of 41 (41.5%) carcinoma samples, whereas all 30 hyperplasia samples were HPV-negative. Differences in p53 codon 72 allelic frequencies were not observed, neither between carcinomas and hyperplasias nor between HPV-positive and HPV-negative carcinomas. CONCLUSION: These results indicate that the p53 genotype is probably not a risk factor for prostate cancer, and that HPV infections could be associated with at least a subset of prostate carcinomas.

Effects of fluoroquinolones on the migration of human phagocytes through Chlamydia pneumoniae-infected and tumor necrosis factor alpha-stimulated endothelial cells.

The anti-inflammatory activities of three quinolones, levofloxacin, moxifloxacin, and gatifloxacin, were investigated with an in vitro model of transendothelial migration (TEM). Human umbilical vein endothelial cells (HUVEC) were seeded in Transwell inserts, treated with serial dilutions of antibiotics, infected with Chlamydia pneumoniae, or stimulated with tumor necrosis factor alpha (TNF-alpha). Neutrophils or monocytes were also preincubated with serial dilutions of each antibiotic. TEM was assessed by light microscopic examination of the underside of the polycarbonate membrane, and levels of interleukin-8 (IL-8) and monocyte chemotactic protein 1 (MCP-1) were measured by enzyme-linked immunosorbent assay. In HUVEC infected with C. pneumoniae or stimulated with TNF-alpha, all fluoroquinolones significantly decreased neutrophil and monocyte TEM, compared to antibiotic-free controls. Moxifloxacin and gatifloxacin produced a significant decrease in IL-8 in C. pneumoniae-infected and TNF-alpha-stimulated HUVEC; however, moxifloxacin was the only fluoroquinolone that produced a significant decrease in MCP-1 levels under both conditions. Results from this study indicate similarities in the anti-inflammatory activities of these fluoroquinolones, although no statistically significant decrease in chemokine secretion was observed when levofloxacin was used. Mechanisms of neutrophil and monocyte TEM inhibition by fluoroquinolone antibiotics are unknown but may be partially due to inhibition of IL-8 and MCP-1 production, respectively.

Effect of macrolide antibiotics on human endothelial cells activated by Chlamydia pneumoniae infection and tumor necrosis factor-alpha.

This study investigated the potential anti-inflammatory activity of 3 macrolide antibiotics, clarithromycin, roxithromycin, and azithromycin, in an in vitro model of transendothelial migration (TEM). Human umbilical vein endothelial cells (HUVECs) were seeded in Transwell inserts, treated with serial dilutions of the antibiotics, and infected with Chlamydia pneumoniae or stimulated with tumor necrosis factor (TNF)-alpha. In HUVECs infected with C. pneumoniae or stimulated with TNF-alpha, both azithromycin and roxithromycin caused significant decreases in neutrophil and monocyte TEM, compared with antibiotic-free controls. Clarithromycin had no detectable effect in either group. Azithromycin caused significant decreases in interleukin (IL)-8 and monocyte chemotactic protein (MCP)-1, whereas roxithromycin significantly decreased IL-8. This study indicates heterogeneity in the anti-inflammatory activity of these antibiotics. Mechanisms of monocyte and neutrophil TEM inhibition by azithromycin and roxithromycin are unclear but may be partially due to inhibition of IL-8 and MCP-1 production.

Psiconeuroinmunoendocrinología en enfermedades autoinmunes (LES) / Psychoneuroimmunoendocrinology in autoimmune disease

When we first defined in 1990 the term Psychoneuroimmunoendocrinology considering the interrelation of both the immune and the endocrine systems, the neurotransmitter receptors and the endocrine systems, the neurotransmitter receptors and the main findings in the field of psychology, an increasing ethusiasm was originated following the expression of these concepts, and rapidly clinical physicians and immunotherapeutists hypothesized the possibility of the existence of a molecular basis in the observations produced daily during their assistance. The authors describe these immuno-neuroendocrinal interactions, with special reference to psychoneuroimmuno-endocrinology in the systemic lulpus erythmatosus

Psiconeuroinmunoendocrinología en enfermedades autoinmunes (LES) / Psychoneuroimmunoendocrinology in autoimmune disease

When we first defined in 1990 the term Psychoneuroimmunoendocrinology considering the interrelation of both the immune and the endocrine systems, the neurotransmitter receptors and the endocrine systems, the neurotransmitter receptors and the main findings in the field of psychology, an increasing ethusiasm was originated following the expression of these concepts, and rapidly clinical physicians and immunotherapeutists hypothesized the possibility of the existence of a molecular basis in the observations produced daily during their assistance. The authors describe these immuno-neuroendocrinal interactions, with special reference to psychoneuroimmuno-endocrinology in the systemic lulpus erythmatosus